Abstract WP96: Impact of Stroke Severity and Social Determinants of Health on Arrival to Last Known Well Time

Abstract

Introduction: Timely administration of thrombolytic therapy remains the cornerstone of ischemic stroke management and is associated with better functional outcomes. The population served by our hospital is notable for a large socioeconomic range of patients. We examined arrival times for ischemic strokes and the timeliness of intervention with our goal to better understand our population and develop methods for improved community outreach and education. Methods: This retrospective study looked at ischemic stroke patients discharged between January-May 2023. Patient characteristics and demographics were mined from the Get With The Guidelines™-Stroke database from NYC Health+Hospitals/Kings County. A total of 284 patients were reviewed. Covariates included in this study: age, sex, ethnicity, initial NIHSS score, payment source, and history of previous stroke. Adjusted linear regressions were used to analyze data at alpha = 0.05. Results: The median time of arrival to hospital from last known well time (LKWT) is 296min; 37.32% of patients arrived within the 4.5hr window. The average NIHSS score on arrival for patients within the 4.5 hours window is 7.3; patients outside of the 4.5hr window (or unknown LKWT) have an average NIHSS of 5.17. (See distribution of NIHSS score by LKWT category in Fig. 1 below.) Out of the 284 patients, a noted association was seen between severity of NIHSS and LKWT reported: the LKWT was lower by 16.47min (23.68-9.24, p > 0.02) for every increase in NIHSS point. Additionally, compared to patients with no health insurance, those with private insurance have a decrease in LKWT of 1506.04min (1878.6-1133.5, p < 0.0001), and those with Medicare/Medicaid have a decrease in time of 1291.83min (1652.1-931.5, p > 0.0004). Conclusion: Review of patients in early 2023 showed a relationship between LKWT reporting and stroke severity as well as insurance status. These findings will help direct future projects in community education and outreach.