The study (Older Stroke Patients with High Stroke Scores Have Delayed Door- to- Needle Times published in Journal of Stroke and cerebrovascular diseases Vol 25, Issue 11) done in San Antonio area, showed that even when matched for higher NIHSS scores and co morbidities, older pts received tPA later than their younger counterparts. This study would evaluate the same in university settings. 

We performed a retrospective analysis on 366 patients seen in University hospitals from Jan 2012 to Dec 2017 with acute ischemic stroke, who received tPA in < 4.5 hrs from symptom onset. Patients excluded by ECASS criteria. Variables were compared using Chi square test and Logistics Regression analysis was performed on independent variables. 

The results were not significant for individual analysis for DTN time in older population with higher NIHSS scores. The results were not significant for the interaction of the age*NIHSS as well. In the multinomial analysis, for all variables combined, only significant factor was presenting systolic BP, that was significant for DTN time, which is a known factor in delaying treatment.

The results of this study were different from the prior similar study conducted in San Antonio region. The main difference in study was presence of an on site neurologist in the university health care system versus tele neurology in community hospitals.