Razia Rehmani MD, Presenter: Nothing to Disclose

Philippe Chu MD, Abstract Co-Author: Nothing to Disclose

Vinodkumar Velayudhan DO, Abstract Co-Author: Nothing to Disclose

Michael H. Lev MD, Abstract Co-Author: Speaker, General Electric Company Advisory Board, General Electric Company Research support, General Electric Company Speaker, Bracco Group Advisory Board, Bracco Group Advisory Board, CoAxia, Inc Consultant, Vernalis plc Speaker, Vernalis plc

Steven Lev MD, Abstract Co-Author: Nothing to Disclose

CT time is paramount in triaging acute stroke patients receiving IV thrombolysis, which must be performed within 3 hours of symptom onset.  We critique our experience as a designated NYS Stroke Center, emphasizing potential areas for improvement in "door-to-CT" time.

We reviewed the clinical and radiological findings of patients presenting to our Level I trauma center ED with acute stroke during 2007. Brief MD assessment, utilizing the NIH Stroke Scale, was instrumental in activating a multidisciplinary stroke team. 24 hour radiology coverage is available and upon alert the CT scanner is cleared. Hemorrhage is an absolute and a "large" hypodensity is a relative contradiction to IV thrombolysis. Diagnoses are recorded on American Stroke Association tracking forms. Data and performance were correlated to NYS benchmarks and NINDS guidelines.

263 patients were diagnosed with acute stroke, versus 16,836 at NYS hospitals. 76% of the 54 patients arriving within 3 hours were evaluated within the 10 minute guidelines. In the 5 of the 54 associated with EMS prenotification, door-to-MD time was reduced to under 3 minutes. Stroke team was activated within 15 minutes for 71.5% of the t-PA candidates and 81% had CT performed within 25 minutes. 4.8% of 263 had intracerebral and 3.4% had subarachnoid hemorrhage. All given IV t-PA (7/263) met the 25 minute door-to-CT and 45 minute door-to-interpretation recommended times.

Optimal CT door-to-imaging/interpretation times can be achieved at a community teaching hospital through effective interdepartmental communication.  

QA time “drill-downs” are essential to program success. EMS prenotification makes a difference.

Rehmani, R, Chu, P, Velayudhan, V, Lev, M, Lev, S, Time Is Brain: "Getting with the Guidelines" to Optimize Door-to-CT Time in IV Thrombolysis Triage.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6007848.html