Abstract
Introduction: Faster treatment time for acute ischemic stroke is associated with better outcome. We hypothesized that patient factors such as young age, female sex, premorbid mental health (depression, anxiety, schizophrenia, bipolar) or other conditions (fibromyalgia, chronic pain), may confound making the diagnosis of stroke and thus delay door to needle (DTN) time. Methods: Consecutive patients who received intravenous tPA in our comprehensive stroke center emergency department between January 2015 and June 2018 were reviewed regardless of discharge diagnosis. The primary outcome was DTN time, and secondary outcomes were door to CT imaging (DTI) time and CT read to needle time. Univariate analyses were done using parametric and non-parametric tests and linear regression model was developed with variables with p values <0.15. Results: A total of 225 patients (mean age 63.7 ±15.5 y, 48% women, 67% white, 32% African American, 1.8% other) were identified. Mean DTN was 63 minutes. Patients < 60 y had a mean DTN time of 67.2 minutes vs 60.9 minutes in those > age 60 y (p=0.093). Age <60 was associated with increased mean DTI time (28.6 minutes vs 21.6 minutes in patients > 60; p=0.0068; mean difference of 7 minutes, 95%CI of 2.0, 12.1). There was no significant difference in CT to needle time by age (p=0.77). A known mental health diagnosis or other confounding condition was present in 37%. Four of 225 (1.7%) had schizophrenia, with median DTN time of 91 vs 56 minutes in those without (p=.14). Linear multivariate regression model showed that younger age (p=0.018) and schizophrenia (p=0.009) were independently associated with longer DTN times. Conclusion: Longer DTI times were associated with age less than 60, and longer DTN times were associated with younger age and presence of schizophrenia. Recognition of younger age and schizophrenia by clinicians as confounders could help reduce stroke treatment times.
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