To compare the clinical characteristics, code stroke time metrics, complications and functional outcomes among patients who received intravenous tissue plasminogen activator (IV t-PA) for an ischemic stroke that developed during their hospitalization in a tertiary medical care center with neurology residents versus hospitals without neurology residents.

Current literature of in-hospital stroke (IHS) has largely found poor functional outcomes upon discharge and higher mortality with factors such as delayed recognition time and delay in assessment, playing a role in unfavorable outcomes. A resident based acute stroke protocol has been shown to be safe and more efficient, but the literature for IHS patients within teaching hospitals needs better elucidation.

Using a network database including all in-hospital code strokes, data were retrospectively abstracted between 2010-2018 within a large tertiary hospital with neurology residents (LAMC) and 11 other medical centers (non-LAMC) without neurology residents. Data was analyzed using Wilcoxon Rank Sum Test.

101 patients were identified, 72 at LAMC and 29 at non-LAMC hospitals. There was no difference in baseline characteristics. More patients underwent endovascular intervention, ie. IA t-PA, thrombectomy or both (12.87%) at LAMC compared to non-LAMC (0.99%). There was no difference in the rate of complications between the two groups, though LAMC had 4 patients (3.96%) who developed symptomatic ICH/PH-2 hemorrhage, 3 (2.97%) of which required surgical intervention. Neurology evaluation was quicker at LAMC (15mins, IQR 10 – 27.5mins) vs non-LAMC (27mins, IQR 10 – 50mins) p=0.04. Time from symptom recognition to t-PA administration was shorter at LAMC (67mins, IQR 48.5 – 95.5mins) vs non-LAMC (96mins, IQR 80 – 104min) p=0.001. There was no significant difference in functional outcome, including NIHSS at 24 hours, NIHSS at 3 days and mRS at 90 days.