Introduction: Functional outcomes and quality of life are known benefits of Activase treatment in acute ischemic stroke (AIS), however, benefit is highly time dependent. Prior studies demonstrate that women and black patients with AIS are less likely to be treated with Activase in < 60 minutes. Utilization of best practice strategies identified in Target Stroke I & II has been an ongoing process improvement initiative at our facility since 2009.
Purpose: Our goal was to understand if disparities in Door to Needle Time (DTNT) exist by age, race, or gender at our Joint Commission certified CSC with utilization of best practice strategies.
Methods: A retrospective chart analysis with comparison of average DTNT by age, race and gender was performed on all AIS patients receiving Activase in our CSC from 2009-2015 (n=297). Differences in DTNT were analyzed using Student’s t-tests, ANOVA, and linear regression.
Results: Median DTNT for all patients was 56 minutes (Male 58, Female 56, Black 61, and White 56). Average DTNT by age did not show any significant correlation with a R2=0.003 (F:0.98 p=0.322). Additionally, there were no significant differences among classified age categories (18-55, 56-80, 81-90, 91+; p=0.50). Average DTNT for females and males were observed to be 62.6 (95% CI 58.6-66.7) and 61.0 (95% CI 57.1-65.0), (p=0.57). Average DTNT for Blacks and Whites were observed to be 64.9 (95% CI 56.8-73.0) and 61.1 (95% CI 58.1-64.2), (p=0.35). Further analysis of gender by race classification demonstrated no significant differences in average DTNT (Black-Female 66.7, Black-Male 64.0, White-Female 62.1, White-Male 60.4 - F:0.44 p=0.73).
Conclusion: No disparities in DTNT were found for age, race or gender at our CSC from 2009-2015. Target Stroke may have contributed to the absence of disparities. Comparison of DTNTs by age, race and gender before and after instituting Target Stroke at our CSC, other certified centers, and non-certified centers, is planned for our region. Further analyses will include arrival mode, payer source, stroke severity on arrival, off hour presentation, symptomatic hemorrhagic transformation rates, functional outcomes, and discharge disposition.