Abstract TMP71: Non-Enhanced Computed Tomography to Computed Tomography Angiogram Performance Times: Telestroke versus Bedside Neurologists

Abstract

Introduction: The 2015 AHA/ASA Stroke Management Guidelines strongly recommend that if endovascular therapy is contemplated, a Computed Tomography Angiogram (CTA) be included in the initial imaging evaluation. Telestroke neurologists evaluating patients at Non-endovascular Stroke Centers (NESCs) are mostly focused on achieving quick door-to-needle (DTN) intravenous (IV) tPA times, not prompt CTA performance times to facilitate expeditious endovascular treatment for large vessel occlusion (LVO) acute ischemic stroke (AIS) patients. Hypothesis: The Non-Enhanced Computed Tomography (NECT) to CTA time interval for LVO patients evaluated by telestroke neurologists at NESCs is significantly longer than for LVO patients initially evaluated at Endovascular Stroke Centers (ESCs). Methods: From a large healthcare system’s stroke network database, we conducted a retrospective analysis comparing the NECT to CTA time performance interval for consecutive patients initially presenting to any one of 23 different hospitals or freestanding emergency departments who were identified as having an LVO AIS and met candidacy for ESC transfer. Results: Over 7 months, we identified 71 LVO cases initially presenting to one of 21 NESCs covered by teleneurologists and 62 cases from one of 2 ESCs covered by bedside neurologists. After removing the outliers (>95th percentile for ESC cases and >90th percentile for NESC cases), we retained 64 cases from NESCs and 59 from ESCs for our analysis. NECT to CTA times were significantly longer at the NESCs than at the ESCs, with NECT to CTA means of 27.94 minutes (SD: 24.93, IQR: 41.5) for NESC cases versus 10 minutes (SD: 3.29, IQR:4) for ESC cases (Kolmogorov-Smirnov test asymptotic p-value 0.0001), Conclusion: The NECT to CTA performance time interval for LVO AIS patients evaluated at NESCs by telestroke neurologists is significantly longer than for LVO AIS patients evaluated at ESCs. These data suggest that steps should be taken to ensure that NECT to CTA time intervals receive the same attention as DTN IV tPA times in assessing overall telestroke neurologist process performance.