Time to Imaging and Functional Outcomes: Visualizing Predictive Trends between Door-to-Imaging, NIHSS, and mRS
María Cedeño1, Sabrina Lora1, Ramon Antonio Romano Peralta2, Stephanie Castro1, Cesarina Torres Vásquez1, Francisco Méndez3, Edwina Luna Rodríguez1
1Neurology Department, 2Department of Knowledge Management and Epidemiology, 3Emergency Department, Centers for Diagnostic and Advanced Medicine and Medical Conferences and Telemedicine (CEDIMAT)
Objective:
Correlate door-to-imaging time (DIT) with functional status at discharge, and visualize predictive trends involving DIT, NIHSS, and modified Rankin Scale (mRS).
Background:
Acute ischemic stroke (AIS) is a leading global cause of death where prompt management is vital; guidelines recommend imaging within 25 minutes of hospital arrival1,2. Delays in stroke patients’ care negatively affect outcomes, particularly in resource-limited settings, making it crucial to understand the impact of diagnostic imaging time on prognosis.
Design/Methods:
Retrospective longitudinal study of AIS patients at a stroke unit in the Dominican Republic from January to September 2024. Data from electronic records included demographics, NIHSS, DIT, and discharge mRS. Descriptive statistics summarized data, and ordinal logistic regression (OLR) evaluated the relationship between DIT and mRS, adjusting for age, sex, delta NIHSS, and reperfusion therapy. Predicted margins analyzed trends for each mRS category. Analyses were performed in STATA.B18, with significance at p=<.05 and mean imputation for missing data.
Results:
The study registered 150 patients (mean age of 67.5 years [±15.52], 59.3% male, 42.7% with DIT ≤25-minutes). OLR showed that each additional minute in DIT slightly decreased the odds of worse mRS scores (OR=0.999, CI=0.999–1.000, p=.075). Adjusting for age and reperfusion therapy produced similar findings, while increases in age and reperfusion raised the odds of worse mRS outcomes by 2.9% (OR=1.03, CI=1.009–1.053, p=.006) and 36% (OR=1.36, CI=0.496-3.727, p=.550), respectively. Each unit decrease in NIHSS from admission to discharge decreased the odds of a worse outcome by 7.6% (OR=0.924, CI=0.843-1.014, p=.096). Male patients had 66.3% higher odds of greater mRS scores, but this was not statistically significant (OR=1.663, CI=0.913-3.030, p=.096).
Conclusions:
DIT did not significantly impact outcomes, but NIHSS and age were strong predictors, suggesting that symptom severity at admission may be more critical for stroke outcomes. These insights can aid resource-limited countries in developing strategies to address treatment delays, improving patient care.
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