Last Known Well To Acute Stroke Treatment Time Is the Key Factor For A Good Outcome As Measured by Modified Rankin Score at 1-Year post Discharge Follow-Up
Background/Purpose: The modified Rankin Scale (mRS) is a scale for measuring the degree of disability or dependence in the daily activities of patients. It is also used as a clinical outcome measure for stroke, with 0-2 equals good outcome and 3-5 equals poor outcome. In 2015, our stroke program set out to measure the long term clinical outcome of our stroke patients who have received intravenous (IV) and/or mechanical thrombolysis, by following these patients for 1 year via telephone interview. By the end of 2016, our data shows that 75% of these patients have a mRS of 0-2 at 1-year follow up. While our data reflects the effectiveness of our stroke program, we also analyzed the data to investigate the commonality in the care of patients who have a good outcome versus poor outcome long term.
Methods: mRS is collected at discharge, 30-day, 90-day, 6-month, and 1-year by telephone interview by stroke program coordinator, on patients who received IV and/or mechanical thrombolysis in 2015. After 1 year, patients with mRS 3-5 at discharge are divided into two groups. Group 1 have patients with mRS 0-2 at 1 -year, and Group 2 made up of patients with mRS 3-5 at 1-year. We then compared factors that could have contributed to the clinical outcome - Age, Door-to-tissue plasminogen activator (tPA) time, Last Known Well (LKW) to tPA time, LKW to Angio Suite, stroke severity, and discharge disposition.
Results: 72 patients were reviewed. 44 patients retained at 1 year follow up. 18 patients in Group 1 and 6 patients in Group 2. The most significant factor for a good outcome is the LKW to treatment time. Group 1 has a median LKW to tPA time of 108 minutes and LKW to Angio time of 138 minutes; while Group 2 has 208 minutes and 238 minutes, respectively. Looking at LKW to tPA between Group 1 and Group 2 - the t-value is -3.40249. The p-value is 0.001494. The result is significant at p<0.05. For the same 2 groups looking at LKW to Angio time, the t-value is -3.55212. The p-value is 0.002268. The result is significant at p<0.05.
Conclusion: Last Known Well to acute stroke treatment time is the key factor for good stroke clinical outcome.