Stroke Severity May Impact Speed of Diagnosis & Thrombolysis (P04.058)

Abstract

Objective: To demonstrate that clinical severity affects speed of diagnosis and treatment of acute ischemic stroke. Background Prior stroke treatment trials demonstrate that earlier thrombolysis leads to greater benefit; however, recent data suggests that less than 1/3 of stroke patients had door-to-needle times Design/Methods: Retrospectively, all acute ischemic stroke patients who received IV rt-PA alone were identified in our stroke database. Patients who received IA rt-PA or mechanical thromboembolectomy were excluded from analysis. Door-to-needle times and NIHSS scores at admission and discharge were identified. Statistical analysis was done using the Mann-Whitney test and a regression model for adjustment of admission NIHSS score severity. Results: IV rt-PA alone was given to 112 AIS patients; 8 lacked discharge NIHSS scores, so 104 were included for analysis. Fifty received IV rt-PA within 60 minutes, 54 after 60 minutes. Mean admission NIHSS scores were 11.2 and 8.8 (p=0.016) for the 60min groups, respectively. The mean improvements in NIHSS scores at discharge were 6.9 and 5.1 (p=0.606), respectively. When the same data set was dichotomized at a target of 80 minutes, the admission scores were 10.6 ( 80min, n=24) (p=0.142). The mean improvements in NIHSS scores for this time dichotomization were 6.8 and 3.0 (p=0.033), respectively. Conclusions: Our experience suggests that greater stroke severity is associated with earlier diagnosis and treatment. When stroke severity on admission is adjusted, the data shows a greater degree of improvement for patients who are treated earlier, confirming prior reports in the literature. Our data may also suggest that less severe stroke cases may present more of a diagnostic challenge, which may delay treatment; however, further review of nation-wide data is necessary to fully answer this question. Disclosure: Dr. Nair has nothing to disclose. Dr. Wang has nothing to disclose. Dr. McNeil has nothing to disclose. Dr. Wang has nothing to disclose. Dr. Jahnel has received personal compensation for activities with Genetech as a Consultant. Dr. Stapel has nothing to disclose. Dr. Stapel has nothing to disclose. Dr. Stapel has nothing to disclose. Dr. Stapel has nothing to disclose. Dr. Beck has nothing to disclose. Dr. Alanis has nothing to disclose. Dr. Talkad has received personal compensation for activities with Genentech, Inc. as a speaker. Dr. Wang has received personal compensation for activities with Sanofi-Aventis Pharmaceuticals, Inc. and Boehringer Ingelheim Pharmaceuticals, Inc.