Abstract TP495: Symptom Onset To Arrival Time And Outcomes Among Acute Ischemic Stroke Patients, Paul Coverdell National Acute Stroke Program (PCNASP) 2016-2018

Abstract

Introduction: Early use of intravenous (IV) alteplase among those with Acute Ischemic Stroke (AIS) has been associated with better outcomes. However, many patients are ineligible for treatment due to late arrival or contraindications. We used PCNASP data to examine the descriptive characteristics and clinical outcomes associated with arrival time. Methods: A total of 233,794 patients were identified with an AIS in PCNASP data from 2016-2018. A total of 131,195 (56%) patients had documented last known well time (LKW). Symptom onset to arrival times (OAT) were categorized into the following using LKW and ED arrival times: 0-2, >2 and ≤3, >3 and ≤4.5, >4.5 hours. We assessed associations between OAT and two outcomes - discharge to home and independent ambulation at discharge using generalized estimating equations (GEE) modeling. Results: Patients with documented LKW time had the following OAT: 39,694 (30.3%) 0-2 hours, 11,573 (8.8%) >2 and ≤3 hours, 13,582 (10.3%) >3 and ≤4.5 hours, and 66,346 (50.6%) >4.5 hours. Overall, 51% were male, 75% were Whites, and 51% of patients arrived by ambulance. Only 17% of patients received IV alteplase. After adjusting for age, sex, race, arrival by ambulance, stroke severity score, and IV alteplase use, compared to those arriving >4.5 hours of symptom onset, patients arriving ≤4.5 hours were more likely to be discharged to home (0-2, 1.85 [1.79, 1.92]; >2 and ≤3, 1.38 [1.32, 1.45]; >3 and ≤4.5, 1.13 [1.08, 1.18]; referent >4.5), and independently ambulate at discharge (0-2, 1.89 [1.82, 1.96]; >2 and ≤3, 1.41 [1.34, 1.48]; >3 and ≤4.5, 1.15 [1.10, 1.21], referent >4.5) (Table). Conclusion: In this study, shorter OAT were associated with better outcomes for AIS patients. Although significant progress has been made in the early management and treatment of stroke, continued efforts are needed to emphasize the significance of early hospital arrival and promote implementation of treatment guidelines to improve clinical outcomes for all stroke patients.