David Benjamin Weinreb MD, Presenter: Author, NeuroLogica Corp

James E. Stahl MD, Abstract Co-Author: Nothing to Disclose

The National Institute of Neurological Disorders and Stroke (NINDS) recommends that all patients presenting with signs of acute stroke undergo CT imaging within 25 minutes of their arrival in the Emergency Department. The objective of the present study is to determine whether the addition of a portable CT scanner dedicated for use in the Emergency Room increases compliance with this recommendation and, furthermore, whether it would be associated with a higher percentage of patients eligible for thrombolytic therapy.

We acquired a portable 8-slice head/neck CT scanner (CereTom, NeuroLogica, Danvers, MA) for the Emergency Department. Time elapsed from the physician’s request for STAT head CT imaging was recorded for the one-month prior to and the four-month period following the acquisition of the portable scanner. We analyzed the data with a discrete-event simulation modeling approach, in which entities (eg, patients) compete with each other for limited resources, specifically CT time.

Portable CT imaging was associated with a reduction from 34.55±2.2 minutes (n=127) to 15.88±2.4 minutes (n=281), or 54%, in the time elapsed from the physician’s request to when the scan was performed (p<0.001). Discrete-event simulation modeling demonstrated that the portable scanner would reduce the time from symptom onset to CT imaging from 4.16 to 3.76 hours (9.6%). Consequently, this would increase the predicted percent of patients to be treated with thrombolytic therapy within the 3 hour therapeutic window from 0.59% to 1.1% (86% increase).

Our institution’s acquisition of a portable CT scanner facilitated more rapid assessment of acute stroke patients and is anticipated to increase the number of patients for whom thrombolytic therapy can be administered.

Portable CT imaging may be a cost-effective approach to achieve compliance with NINDS recommendations.

Weinreb, D, Stahl, J, The Introduction of a Portable Head/Neck CT Scanner May Be Associated with an 86% Increase in the Predicted Percent of Acute Stroke Patients Treatable with Thrombolytic Therapy.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6018537.html