Emergency department arrival times after acute ischemic stroke during the 1990s.
BACKGROUND
Only 8% of ischemic stroke (IS) patients are eligible for rt-PA, and the largest exclusion criterion is delayed time of presentation to the ED. We sought to investigate whether patients are arriving to the ED more quickly in 1999 than in 1993/94 within our large biracial population of 1.3 million.


METHODS
Using ICD-9 codes 430-436, we ascertained all stroke events that presented to a local ED within our population in 7/93-6/94 and again in 1999. Times were recorded as documented in the medical record.


RESULTS
There were 1,792 IS patients that presented to an ED in 1993/94 and 1,973 in 1999. The percentage of patients with documented times arriving in under 3 h improved slightly in 1999 (26% vs. 23% in 93/94, P = 0.03), however, the percentage arriving in under 2 h did not. Blacks significantly improved in arrivals under 3 h: 26% in 1999 compared to 17% in 1993/94 (P = 0.01), while whites did not (26% vs. 25%, P = 0.29). In 1999, only 9% of patients arrived from 3-8 h after symptom onset, the large majority of times were either estimated, unknown, or >8 h.


CONCLUSIONS
We found only marginal improvement in arrival times during the 1990s. In our population, blacks improved in early arrival after symptom onset, while whites did not. Very few patients arrive 3-8 h after onset; therefore expansion of the acute treatment time window to 8 h is unlikely to dramatically affect acute treatment of ischemic stroke.
Kleindorfer
Dawn O
DO
University of Cincinnati Medical Center, 231 Albert Sabin Way, MSB Room 5059A, Cincinnati, OH 45267-0525, USA. dawn.kleindorfer@uc.edu
Broderick
Joseph P
JP
Khoury
Jane
J
Flaherty
Matthew L
ML
Woo
Daniel
D
Alwell
Kathleen
K
Moomaw
Charles J
CJ
Pancioli
Arthur
A
Jauch
Edward
E
Miller
Rosie
R
Kissela
Brett M
BM
D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000706:statistics & numerical data; D002545:Brain Ischemia / Q000150:complications / Q000208:ethnology / Q000628:therapy*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D012189:Retrospective Studies; D020521:Stroke / Q000208:ethnology / Q000209:etiology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data