Abstract
Introduction: With the recent positive clinical trial extending the time window for endovascular therapy out to 24 hours, we sought to describe the arrival times of acute ischemic stroke patients within the 6-24 hour time frame within a large biracial population representative of the US in terms of % black, age, and socioeconomic indicators. Methods: We identified all ischemic stroke (IS) cases by screening all local hospital ICD-9 codes 430-436 among residents of the Greater Cincinnati/Northern Kentucky Stroke Study region, a biracial population of 1.3 million in 2010. Study nurses abstracted relevant information from the medical record, including symptom onset and ED arrival times, and all potential cases were physician reviewed. Arrival time was defined as the elapsed time between symptom onset time (either the witnessed onset time, or time last seen normal) and time of ED arrival. Only cases presenting to an ED were included in this analysis. Student’s t-test and Wilcoxon rank sum tests were used as appropriate. Results: In 2010, there were 1980 IS cases presenting to a local emergency department, who were 21.3% black, 55.1% female, with a median age of 69.4 (SD 14.9). See Figure for distribution of arrival times. Patients arriving > 6 hours were significantly younger (age 68.8 vs. 70.7, p=0.007), more frequently female (56.6% vs. 52.0%, p = 0.05) and had less severe infarcts (NIHSS median (IQR) was 3 (1-6) vs. 4 (1-11), p<0.0001), compared to those arriving </= 6 hrs. No significant differences by race or baseline disability were observed. Discussion: In our population, inclusion of 6-24hr ED arrival times allows 34% more of our ischemic stroke population to be arriving within a timeframe of possible intervention/reperfusion therapy. Further exploration of eligibility criteria, in addition to time, for extended time-window embolectomy within a population is needed to assist centers as they change their systems of care.
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