Door-to-Needle Delays in Minor Stroke: A Causal Inference Approach.

Abstract:

BACKGROUND AND PURPOSE:Thrombolysis rates among minor stroke (MS) patients are increasing because of increased recognition of disability in this group and guideline changes regarding treatment indications. We examined the association of delays in door-to-needle (DTN) time with stroke severity. METHODS:We performed a retrospective analysis of all stroke patients who received intravenous tissue-type plasminogen activator in our emergency department between July 1, 2011, and February 29, 2016. Baseline characteristics and DTN were compared between MS (National Institutes of Health Stroke Scale score ≤5) and nonminor strokes (National Institutes of Health Stroke Scale score >5). We applied causal inference methodology to estimate the magnitude and mechanisms of the causal effect of stroke severity on DTN. RESULTS:Of 315 patients, 133 patients (42.2%) had National Institutes of Health Stroke Scale score ≤5. Median DTN was longer in MS than nonminor strokes (58 versus 53 minutes; P=0.01); fewer MS patients had DTN ≤45 minutes (19.5% versus 32.4%; P=0.01). MS patients were less likely to use emergency medical services (EMS; 62.6% versus 89.6%, P<0.01) and to receive EMS prenotification (43.9% versus 72.4%; P<0.01). Causal analyses estimated MS increased average DTN by 6 minutes, partly through mode of arrival. EMS prenotification decreased average DTN by 10 minutes in MS patients. CONCLUSIONS:MS had longer DTN times, an effect partly explained by patterns of EMS prenotification. Interventions to improve EMS recognition of MS may accelerate care.

journal_name

Stroke

journal_title

Stroke

authors

Rostanski SK,Shahn Z,Elkind MSV,Liberman AL,Marshall RS,Stillman JI,Williams O,Willey JZ

doi

10.1161/STROKEAHA.117.017386

subject

Has Abstract

pub_date

2017-07-01 00:00:00

pages

1980-1982

issue

7

eissn

0039-2499

issn

1524-4628

pii

STROKEAHA.117.017386

journal_volume

48

pub_type

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