Abstract NS2: Code Neuro Nurses May Improve Door-to-Needle Times in Posterior Circulation Strokes

Abstract

Background: Posterior circulation strokes (PCS) can be more difficult to diagnose than anterior circulation strokes (ACS). Ambiguous symptoms such as isolated vertigo, non-lateralizing signs and low National Institute of Health Stroke Scale (NIHSS) scores have been shown to delay treatment with intravenous (IV) tissue plasminogen activator (tPA) and prolong Door-to-needle (DTN) times. In 2006, this institution implemented the use of Code Neuro Nurses 24/7 as part of a highly developed stroke response system of care, to expedite diagnosis and treatment of all stroke patients. As part of this program, all patients in the Emergency Department (ED) with suspected stroke are evaluated by a Code Neuro Nurse. Anecdotal evidence suggested that overall DTN times improved as a result of the Code Neuro Nurse. But were DTN times still prolonged in PCS patients compared to ACS patients? Purpose: The purpose of this project was to determine if DTN times in PCS were longer than times for ACS, in patients who received IV tPA. Methods: An IRB approved retrospective chart review of ischemic stroke cases in 2011 and 2012 found 145 patients who received IV tPA. Data analysis was performed on data elements contained in the table. Results: Of the 145 patients who received tPA, 15.8% (n=23) had PCS. Age and gender were similar between the two groups. Mean admission NIHSS scores in patients with PCS were lower than scores in ACS patients. There were no differences in mean DTN times for PCS compared to ACS. Mortality and disposition to home were not different between the groups. Conclusion: As expected, the admission NIHSS scores for PCS tended to be lower than for ACS, which can contribute to delays in DTN times. However, there was no statistical difference in DTN times between the two groups. Utilizing the expertise of the Code Neuro Nurse in the ED may be a key factor in accurately and efficiently diagnosing PCS strokes, leading to DTN times comparable to ACS cases.