Abstract P152: Missed Treatment Opportunities and Earlier Stroke Detection Among Hospitalized Patients With Acute Cerebral Infarction

Abstract

Background: In preparation for a quality improvement study, we queried our prospective stroke registry for patients who might benefit from prophylactic monitoring in order to estimate the time advantage to monitoring. Methods: A prospective, single center registry of adult patients (9/20/19-6/30/20) was queried for in-hospital acute anterior circulation strokes. Indications for hospitalization as well as delays from last known well (LKW) to symptom recognition, imaging, and treatment were explored. Results: Of 540 consecutively evaluated adults with acute stroke, 68 (12.6%) developed an anterior circulation infarction while hospitalized, 32 (47.1%) of whom were female with a median age of 66 years (IQR 60-77) and median NIHSS of 14 (IQR 4-22). Four patients (5.9%) received intravenous thrombolysis although another 20 (29.4%) would have been eligible for thrombolysis if not for a delay in symptom recognition. An internal carotid, M1, or M2 occlusion was observed in 13 patients (19.1%), 8 of whom were treated at a median of 198 minutes after LKW (IQR 102-670; Figure). In patients treated endovascularly or with thrombolytics, the delay from LKW to symptom recognition accounted for 55.5% of the delay in care. Conclusions: One-third of patients in this single-center cohort would have been eligible for thrombolysis were it not for delays in symptom recognition. The delay to groin puncture exceeded 3 hours for over half of patients with proximal anterior occlusions. Earlier detection using prophylactic monitoring devices has the potential to reduce this major impedance to stroke care and ultimately improve outcomes.