Abstract NS11: Impact of Substance Abuse on Timely Treatment With rt-PA: A Population-Based Study

Abstract

Introduction: Acute stroke patients intoxicated or with a history of substance abuse may be more difficult to diagnose. We explored the impact of substance abuse on time to treatment with rt-PA in our population. Methods: The Greater Cincinnati Region includes five counties with a population of 1.3 million. We ascertained all stroke patients that presented to hospital emergency departments (ED) in 2005 and 2010. Patients residing in nursing or group homes were excluded. Substance abuse was defined as a history noted in the medical record, or abnormal tox screen/EtOH level on presentation. Door to Needle (DTN) was defined as ED arrival time to rt-PA administration. Wilcoxon signed rank test compared (DTN) times between substance abusers and non- abuse groups. Multivariable regression analyzed the association of DTN with demographics (age, race, and gender), history of hypertension, diabetes and atrial fibrillation, as well as the Primary Stroke Center(PSC) certification status of the presenting hospital. Results: In 2005, 72 non-institutionalized ischemic stroke patients received rt-PA in local EDs; in 2010, 112. Mean age for 184 patients was 70 (13 SD), 18% were black, and 51% female. Substance abuse was present in 34 (18%) patients. Median DTN for substance abusers was 73.5 minutes (25 th , 75 th %tile: 52.0, 93.0) vs. 77.50 minutes (61.0, 99.0) for non- abusers (p=0.25). However, if the presenting hospital was a PSC, the DTN times were substantially and significantly shorter (Table). Discussion: Substance abuse history or current intoxication did not impact DTN for rt-PA treated patients within our population. We did find that arriving to a Primary Stroke Center was associated with significantly shorter DTN times. This suggests that hospital systems impact DTN times more than individual patient-level factors.