2025 American Academy of Neurology Abstract Website

Objective:

To examine the efficacy of Computed Tomography Perfusion (CTP) scans in our institution’s Emergency Department (ED) during acute stroke evaluations.

Background:

In this study we look at past acute stroke imaging data, that was completed prior to acute stroke alerts being staffed consistently by Neurologists. Initial assessment is performed with the National Institute of Health Stroke Scale (NIHSS), followed by CT/CTA/CTP scans as appropriate given the NIHSS score. After scans are completed a decision to give a thrombolytic medication or have the patient taken for mechanical thrombectomy is made. The goal of this study is to evaluate internal stroke alert data to improve acute stroke protocols, be more cost effective, accurate, and have better outcomes for our patients.

Design/Methods:

The records of 405 patients that were seen for acute stroke evaluation in the ED during an 18 month period, from 2021-2022, were reviewed. Data collected included: basic demographic data, NIHSS scores, Modified Rankin Scale (MRS) scores, antiplatelet and anticoagulant use, stroke imaging completed (CT Head, CTA Head and Neck, or CT Perfusion scans), basic labs, if there was a stroke, the location of the stroke, and whether thrombolytics were administered or a thrombectomy was performed.

Results:

For those patients who presented with an NIHSS of 0-2 and had a CTP (74/79, 93.67%), only 22/74 (29.73%) had a confirmed stroke. In patients with an NIHSS of 3-5, 78/80 (97.50%) received a CTP scan, and 41/78 (52.56%) had a confirmed stroke. Finally, those with an NIHSS >5, 203/211 (96.21%) received a CTP scan, and 128/203 (63.05%) had a confirmed stroke.

Conclusions:

The CTP scan was overused from 2021-2022 during the evaluation of stroke alert patients, particularly in patients with NIHSS scores below 3. Further statistical analysis will be completed to determine if there is an optimum NIHSS score for obtaining CTP scans in our patient population.