Abstract WP68: National Database Demonstrates Substantial Delays Between Non-Contrast CT and CT Angiography in Suspected Stroke Patients in 2023

Abstract

Background: Prompt identification of large vessel occlusions (LVOs) leads to shorter door to thrombectomy times and better outcomes. In most stroke centers, both a non-contrast CT (CT) and CT angiography (CTA) are ordered simultaneously in patients suspected to have acute stroke. In some centers, a CT is performed first, and CTA is subsequently obtained if vessel imaging is deemed necessary. Methods : Data on 23,925 patients from 717 hospitals who underwent both CT and CTA imaging processed with Rapid software in the United States from Jan 1, 2023 to June 30, 2023 were queried to determine the time delay between CT and CTA. Rapid software is typically used to evaluate suspected stroke patients for occlusions of major brain arteries and salvageable tissue. Results : A delay greater than 15 minutes between CT and CTA occurred in 4,365 patients (18%). Among the 717 hospitals, 595 (83%) had a median delay of less than 15 minutes, 77 (11%) had 15-30 minute delays and 45 (6%) had greater than 30 minute median delays. Among the 595 high performing hospitals, 57% had greater than 15 minute delays in 10% or fewer patients, 33% of the hospitals had 11-33% of their patients with greater than 15 minute delays, and 10% had 34-50% of patients with greater than 15 minute delays. Conclusion : Nearly 20% of patients have a delay greater than 15 minutes between CT and CTA. Seventeen percent of hospitals had a median delay of greater than 15 minutes and 6% had more than a 30 minute median delay. Even among high performing hospitals, a substantial number of patients had more than 15 minutes delay suggesting these patients were moved off the scanner between scans. Education on reducing CT to CTA time in suspected stroke patients should be targeted to hospitals with substantial delays. Software to identify LVOs on non-contrast CT could significantly reduce the door to diagnosis time for LVOs.