Abstract WP501: Stroke Code Quality Metrics and Functional outcomes: Advanced Practice Providers versus Neurology Residents

Abstract

Background: Advanced Practice Providers (APPs) are important members of stroke code teams. However, the impact of APP involvement on quality metrics and functional outcomes is unclear. We sought to evaluate if APPs perform similarly to neurology residents for stroke code quality metrics and functional outcome at 90 days. Methods: We retrospectively analyzed data of consecutive patients who received thrombolysis (rtPA) and/or underwent thrombectomy in a single center cohort. Demographics, National Institute of Health Stroke Scale (NIHSS), Last known normal (LKN) to emergency department (ED) presentation time, ED door to rtPA time, ED door to skin puncture time, recanalization (mTICI IIb/III) rates and modified rankin scale (mRS) at 90 days were compared between neurology residents and advanced practice providers. Multiple logistic regression was used to determine factors independently associated with a favorable modified rankin scale (mRS) at 90 days. Results: A total of 96 patients were included in the study of which 44 (46%) were managed by neurology residents. Both groups (Residents vs. APPs) were balanced for age (p=0.17), NIHSS (p=0.73), LKN to ED Door time (p=0.17), ED door to tPA time (p=0.28), ED door to skin puncture time (p=0.22) and recanalization rate (p=0.93). Using multiple logistic regression, patients who were managed by neurology residents were 4.1 times more likely to have a favorable outcome (mRS 0-2) at 90 days. (Table) Conclusion: Advanced practice providers (APPs) achieve similar acute stroke code metrics as compared to neurology residents. However, functional outcomes are better in patients managed by neurology residents. Further studies are needed to confirm our findings.