title: Emergency department arrival times after acute ischemic stroke during the 1990s.
abstract: 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.
authors.affiliation: University of Cincinnati Medical Center, 231 Albert Sabin Way, MSB Room 5059A, Cincinnati, OH 45267-0525, USA. dawn.kleindorfer@uc.edu
authors.forename: Dawn O
authors.initials: DO
authors.lastname: Kleindorfer
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Broderick
authors.forename: Jane
authors.initials: J
authors.lastname: Khoury
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Flaherty
authors.forename: Daniel
authors.initials: D
authors.lastname: Woo
authors.forename: Kathleen
authors.initials: K
authors.lastname: Alwell
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Moomaw
authors.forename: Arthur
authors.initials: A
authors.lastname: Pancioli
authors.forename: Edward
authors.initials: E
authors.lastname: Jauch
authors.forename: Rosie
authors.initials: R
authors.lastname: Miller
authors.forename: Brett M
authors.initials: BM
authors.lastname: Kissela
mesh_terms: 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