title: A National Evaluation of Door-to-Imaging Times among Acute Ischemic Stroke Patients within the Veterans Health Administration.
abstract: BACKGROUND
  Rapid brain imaging for ischemic stroke is important for patient outcomes. We sought to determine the proportion of ischemic stroke patients receiving brain imaging within the guideline-recommended 24 hours, and predictors of faster imaging among patients with acute symptoms.
  
  
  METHODS
  Retrospective analysis of Veterans Health Administration (VHA) Office of Performance Measurement Stroke Special Project data. Of 3000 ischemic stroke patients, secondary samples included 649 presenting within 6 hours of onset, and 217 potentially tissue plasminogen activator (tPA)-eligible patients (onset-to-arrival time <3 hours, National Institutes of Health Stroke Scale >2). Two linear regression models examined the association between door-to-imaging time and predictors among secondary samples, accounting for clustering within hospital.
  
  
  RESULTS
  Of the 3000 ischemic stroke patients, 97.1% had brain imaging within 24 hours. Among patients presenting within 6 hours of onset, median door-to-imaging time was 59 minutes (interquartile range [IQR], 33-109). Predictors of faster door-to-imaging time included elevated arrival blood pressure and stroke center presentation. Among the potentially tPA-eligible patients, median door-to-imaging time was 52 minutes (IQR, 31-105); no significant predictors were identified.
  
  
  CONCLUSIONS
  Nearly all ischemic stroke patients at VHA hospitals have door-to-imaging time within 24 hours. There remains room for improvement for timely brain imaging among patients with acute symptom onset.
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: ksauser@partners.org.
authors.forename: Kori
authors.initials: K
authors.lastname: Sauser
authors.affiliation: VHA HSR&D Stroke Quality Enhancement Research Initiative Program, Center for Health Information and Communication, Indianapolis, Indiana; Regenstrief Institute, Indianapolis, Indiana; Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Bravata
authors.affiliation: Department of Medicine, University of Michigan, Ann Arbor, Michigan; Center for Clinical Management Research, Ann Arbor Veterans Affairs Hospital, Ann Arbor, Michigan.
authors.forename: Rodney A
authors.initials: RA
authors.lastname: Hayward
authors.affiliation: Department of Medicine, University of Michigan, Ann Arbor, Michigan; Center for Clinical Management Research, Ann Arbor Veterans Affairs Hospital, Ann Arbor, Michigan; Department of Neurology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Levine
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging / Q000379:methods*; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis*; D015912:Thrombolytic Therapy; D013997:Time Factors; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Stroke; brain imaging; emergency care; veterans