To identify high-risk patients with large vessel occlusions (LVO) efficiently and understand possible barriers in providing them with proper stroke care.
Strokes, a major global health problem, affect 795,000 people/year in the United States. The AHA/ASA guidelines recommend IV-tPA followed by endovascular mechanical thrombectomy performed in a timely manner for acute management of ischemic stroke. Thus, patients with concern for LVO should have immediate imaging of head and neck vessels via Computer Tomography Angiogram (CTA) with/without perfusion.
We performed a retrospective study of patients diagnosed and treated for acute stroke to identify the barriers in finding large vessel strokes. We held a 60-minute presentation on October 24, 2019 for Emergency Medicine Physicians-in-Training and staff to educate them on acute ischemic strokes, thrombectomy outcomes following LVO diagnosis post-angiogram, and perfusion studies. The difference between order times for CT head and CTA, which indirectly measures the provider's ability to identify LVOs, was calculated and compared to pre-intervention data.
Our preliminary results, comparing time from triage to CTA to identify LVOs before and after education, showed the mean time to imaging of the pre-intervention group as 33.62 minutes and post-intervention group as 63.9 minutes, with a difference of 30.29 minutes; t= 1.7, df=33, p= 0.09, 95% CI (-66.36, 5.77). Our post-intervention time was longer, mainly due to patient-related factors like unwilling to consider CTA, delaying MR angiogram due to unavailability during after hours, and initial non-stroke-related presenting symptoms.
The analysis found no significant difference between the groups (p>0.05), so we couldn't reject the null hypothesis of no mean difference in time. In the future, we plan to increase the sample size and reanalyze confirmed strokes vs. stroke mimickers separately. Prior studies have shown benefits in reducing door-to-imaging time for identifying LVOs sooner and performing early thrombectomies for eligible patients, despite our findings.