2026 American Academy of Neurology Abstract Website

Objective:

To compare the door-to-CT (DTCT) and door-to-needle (DTN) times before and after implementation of a streamlined emergency department (ED) acute stroke protocol.

Background:

Time from symptom onset to reperfusion in acute ischemic stroke is a major determinant of infarct size and patient outcomes. Regular updates to existing stroke protocols should be performed to optimize workflow and incorporate new best practices. In early 2025, we revised our ED acute stroke protocol to expedite direct transfer from the triage area to the CT scanner and to administer tenecteplase (TNK) on the CT table for eligible patients.

Design/Methods:

In this observational, retrospective study we compared DTCT and DTN times for patients presenting to the ED with presumed acute ischemic stroke and who were treated with TNK during equivalent 6-month periods before (2024) and after (2025) implementation of the updated ED stroke protocol. T-tests were conducted to evaluate differences in DTCT and DTN needle time between the two periods.

Results:

We included 49 patients, 24 (49%) treated in a 6-month period in 2024, and 25 (51%) treated in 2025. Mean age was 69 (22-91 yrs), 63.3% were female. There was significant decrease in DTCT time from 26 min in 2024 (CI, 21-34.5) to 11 min in 2025 (CI, 9-15) which led to subsequent improvement in DTN times from 62 min (CI, 47.75-72.5) to 45 min (CI, 40-55; p=0.0146).

Conclusions:

Multidisciplinary collaboration and teamwork starting with Emergency Medical Services and involving ED staff and nursing, Neurology, Pharmacy, and Radiology can lead to significant decreased in DTCT and DTN times with the ultimate goal of improving outcomes for acute stroke patients.