Abstract TP389: Association Between Door-To-Needle Time and Aphasia in Patients Treated With IV tPA

Abstract

Introduction: Door-to-needle time (DTN) is associated with outcome in acute ischemic stroke (AIS) patients who are eligible to receive intravenous tissue plasminogen activator (IV tPA). Various factors have been shown to impact DTN time including patient-related factors such as initial refusal or management of hypertension, hospital-related factors such as laboratory tests; and system-related factors all potentially affecting clinical outcomes. Neurological deficits such as aphasia could potentially affect DTN through various mechanisms including difficulty in obtaining accurate last known well time (LKWT), discussing risks vs benefits of IV tPA, etc. We sought to investigate the association between aphasia as a presenting neurological deficit and DTN. Methods: This was a retrospective chart review of prospectively collected data through Get-with-the-Guidelines from 7/17 to 6/18 at our comprehensive stroke center. Data regarding patient demographics, medical history, last known well time (LKWT), arrival time, door-to-CT time, treatment time, admission National Institutes of Health stroke scale (NIHSS), pre-stroke modified Rankin scale (mRS) were analyzed. Pearson chi-square test was performed to determine association between aphasia and DTN time. Results: Out of 110 patients (mean age 72 years; 59% women) who received IV tPA; 40% had aphasia as part of their clinical presentation. Patients with aphasia were older (76 vs 69 years) and had higher admission NIHSS (13 vs 6). DTN times did not differ significantly between patients presenting with aphasia vs other neurological deficits (44 vs 45 minutes; p=0.84). No difference was observed between door-to-CT time (16 vs 18 minutes) and LKWT-to-treatment time (138 vs 142 minutes). Conclusion: We did not find significant differences in tPA treatment times in patients with AIS based on the presence or absence of aphasia. Although aphasia could present challenges in the evaluation of patients with AIS, the increased severity of neurological deficits inherent to aphasia may lead to a faster work flow. A small sample size is a major limitation of our study. Further research into the influence of aphasia and other presenting neurological symptoms on DTN is warranted.