Abstract TP275: Impact of a Direct to Computed Tomography Protocol on Tissue Plasminogen Activator Door-to-Needle Time in Acute Ischemic Stroke

Abstract

Background: Current American Heart Association/American Stroke Association (AHA/ASA) guidelines recommend brain imaging with computed tomography (CT) within 20 minutes of emergency department (ED) arrival and treatment with tissue plasminogen activator (tPA) in eligible patients with acute ischemic stroke within 60 minutes of arrival. In January 2017, we implemented a direct-to-CT protocol which consisted of direct patient transportation by emergency medical services (EMS) personnel from ambulance to CT scanner. Patients were then transported to the ED for evaluation and treatment as appropriate via telemedicine and ED staff. Objective: To determine if a direct-to-CT protocol would improve the percentage of patients with door-to-needle (DTN) time ≤ 60 minutes. Methods: This was a single center retrospective cohort study of patients who received tPA for acute ischemic stroke in the ED between October 2016 and May 2018. Patients were grouped based on the use of a direct-to-CT protocol. Results: Of 64 included patients, 23 patients (36%) were transported via the direct-to-CT protocol and 41 patients (64%) arrived via private vehicle or EMS without use of the protocol. Goal DTN time ≤ 60 minutes was achieved in 78% of patients when the protocol was used compared to 44% when it was not (p=0.0078). The mean DTN time was significantly shorter when the protocol was used (52.83±13.8 vs 70.98±32.6, p=0.003). Following adjustments for time of day and the need for blood pressure management with intravenous anti-hypertensives, a greater percentage of patients in the direct-to-CT protocol group achieved DTN ≤ 60 minutes (OR=8.09;95%CI=1.99-32.91, p=0.003). Conclusions: An EMS activated direct-to-CT protocol improved the percentage of patients achieving DTN ≤ 60 minutes and significantly reduced mean DTN time.