Abstract Details

Title Optimizing Overall Management Times for Emergency Department Stroke Code Protocols - Lone Star Stroke Research Consortium

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P12 - Poster Session 12 (11:45 AM-12:45 PM)

Poster/Presentation
Number 13-018

Objective

To identify patterns during stroke codes based on etiology (ischemic stroke, hemorrhagic stroke, and stroke mimics), which could serve as potential opportunities for improvement.

Background Stroke code performance metrics often focus on true acute ischemic stroke (AIS) cases and exclude intracerebral hemorrhage (ICH) and stroke mimics (SM). The NASCARE-3 study utilized insights from an expert panel within a statewide Texas research consortium to analyze stroke code activations for patients admitted to a tertiary stroke center in Texas on September 2024.

Design/Methods Stroke codes were categorized as AIS, ICH, or SM. Various metrics were then analyzed and categorized based on the diagnosis of the patient. All values were recorded as mean (SD). Statistical analysis used SAS v9.4 to build Kruskal-Wallis and Chi-Square models to explore omnibus differences.

Results The 123 stroke codes analyzed included 95 SM, 24 AIS, and 4 ICH. Significant differences were observed across groups in several metrics: diastolic blood pressure [89.0 (17.2) vs. 83.0 (16.6) vs. 113.5 (1.7) mmHg; P<.005]; NIHSS score [4.2 (6.4) vs. 6.5 (8.1) vs. 16.5 (12.3); P<.05]; door-to-ED physician arrival times [60.6 (173.3) vs. 115.1 (184.3) vs. 23.5 (47.0) minutes; P<.05]; door-to-stroke team arrival times [135.8 (281.6) vs. 182.8 (153.9) vs. 48.5 (97.0) minutes; P<.005]; door-to-imaging times [90.1 (196.7) vs. 82.2 (78.5) vs. 21.0 (29.4) minutes; P<.01]; and door-to-glucose time [61.7 (175.7) vs. 42.8 (58.3) vs. 6.8 (11.6) minutes; P<.04].

Conclusions These results highlight the importance of refining stroke code processes regardless of different stroke subtypes, as significant variations in key metrics such as door-to-ED physician arrival, door-to-stroke team arrival, and door-to-imaging times were observed. Placing equal emphasis on the stroke code process for all stroke differentials offers significant potential to enhance hospital quality improvement initiatives. Implementing a go/no-go model for stroke code activation across hospital systems could enhance both efficiency and patient care.

Authors/Disclosures
Yohan Kim, DO (UTSW) PRESENTER	Dr. Kim has nothing to disclose.
Sidarrth Prasad, MBBS (University of Texas, Southwestern Medical Center)	Sidarrth Prasad has nothing to disclose.
Suzanne Stone (University of Texas Southwestern)	Suzanne Stone has nothing to disclose.
Mehari Gebreyohanns, MD, FAAN (UT Southwestern Medical Center)	Dr. Gebreyohanns has nothing to disclose.
Nneka L. Ifejika, MD (Ochsner Health)	Dr. Ifejika has nothing to disclose.
Erica M. Jones, MD, MPH (UT Southwestern Medical Center)	The institution of Dr. Jones has received research support from NIH KL2.
Kim Barker, MD	Dr. Barker has nothing to disclose.
Sean I. Savitz, MD	Dr. Savitz has nothing to disclose.
Salvador Cruz-Flores, MD, FAAN (Paul L. Foster School of Medicine Texas Tech University Health Sciences Center)	The institution of Dr. Cruz-Flores has received research support from University of Texas System.
Steven Warach, MD, PhD (Dell Medical School, The University of Texas at Austin)	Dr. Warach has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. The institution of Dr. Warach has received research support from State of Texas. Dr. Warach has received publishing royalties from a publication relating to health care.
Mark P. Goldberg, MD (UT Health San Antonio)	The institution of Dr. Goldberg has received research support from NIH. The institution of Dr. Goldberg has received research support from State of Texas .
DaiWai Olson	The institution of DaiWai Olson has received research support from Neuroptics. The institution of DaiWai Olson has received research support from Chiesi.

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