Abstract NS1: Thrombolytic Door to Needle Times: Impact of Additional Multimodal Neuroimaging With Initial Imaging for All Patients versus Large Vessel Occlusion Screen Triage

Abstract

Background: Comprehensive Stroke Program identified increased thrombolytic door to needle times [DTN-t] for stroke alert patients [SA]. To increase numbers treated with [w/] mechanical thrombectomy [MT], the decision was made to perform additional multimodal neuroimaging [AMN] w/initial imaging for all SA & before thrombolytic. Prior to this, the Vision, Aphasia, Neglect [VAN] Large Vessel Occlusion [LVO] screening tool was used to triage for AMN. When compared to LVO screen triage, AMN for all SA demonstrated an overall increase in neuroimaging without increasing sensitivity of MT triage [Patterson et al, 2023]. Purpose: Evaluate impact of AMN w/initial imaging for all SA on timely administration of thrombolytic. Method: Retrospective review of 220 SA receiving thrombolytic over 24-months was conducted, w/38 excluded for documented valid delay reasons & 156 receiving AMN before thrombolytic. The NIHSS was evaluated for components of the LVO screening tool to determine VAN [+] or [-]. For VAN [-] SA time required for AMN was subtracted from DTN-t & adjusted times assigned [A-DTN-t]. The group was divided into all SA, NIHSS 0-5 & NIHSS ≥6 & compared to determine impact on DTN-t. Results: A-DTN-t using LVO screen triage resulted in fewer AMN prior to DTN-t with a 5% increase in DTN-t ≤45 minutes [m] in all groups. For DTN-t ≤30m there was a 5% increase in all SA & in NIHSS ≥6, w/a 2% increase in NIHSS 0-5. Conclusion: Clinical Practice Guidelines state thrombolytic therapy is time-dependent & most beneficial when not delayed for AMN. Performing AMN w/initial imaging & before thrombolytic for all SA resulted in delayed administration of thrombolytic without increasing sensitivity of MT triage when compared to utilizing LVO screen triage.