Comparison of Stroke Codes in the Emergency Room and Inpatient Setting.
BACKGROUND
Outcomes of acute stroke management are time dependent. Intravenous tissue plasminogen activator (t-PA) is indicated within 3-4.5 hours of symptom onset and endovascular intervention within 6 hours. Time to treatment may depend on the patient's location. This study seeks to determine whether there is a difference in the timing of key aspects of stroke codes between the emergency room and the inpatient setting.


METHODS
Stroke codes ending in t-PA administration or endovascular intervention between 2010 and 2013 were included. Emergency room stroke codes were compared with those in the inpatient setting. Data were obtained from the Yarmon Stroke Center log. The variables were time to neurological evaluation, time to computed tomography (CT) scan, time to t-PA administration, time from CT scan to t-PA, and time to endovascular intervention. The variables were compared using the t test.


RESULTS
One hundred twenty-two stroke codes were included (106 from emergency room and 16 from inpatient setting). There was no difference in the time to neurological evaluation (P = .19). The time to CT scan and to t-PA administration was significantly increased in the inpatient group (P ≤ .001 and P = .01, respectively). There was no difference in the time from CT scan to t-PA (P = .09) and in the time to endovascular intervention (P = .21).


CONCLUSIONS
Our results show that in the inpatient setting, there was a significant delay in the time to CT scan and to t-PA administration and that the source of the delay is the time to CT scan.
['Garcia-Santibanez|Rocio|R|', 'Liang|John|J|', 'Walker|Amy|A|', 'Matos-Diaz|Ivan|I|', 'Kahkeshani|Kourosh|K|', 'Boniece|Irene|I|']
D059019:Clinical Coding D015331:Cohort Studies D004636:Emergency Service, Hospital D005260:Female D005343:Fibrinolytic Agents D006801:Humans D007297:Inpatients D008297:Male D020521:Stroke D010959:Tissue Plasminogen Activator D014057:Tomography, X-Ray Computed D016896:Treatment Outcome
Stroke code emergency room inpatient in-hospital