title: Comparison of Stroke Codes in the Emergency Room and Inpatient Setting.
abstract: 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.
authors.affiliation: Department of Neurology, Mount Sinai Beth Israel, Icahn School of Medicine, New York, NY. Electronic address: rgarciasantibanez@gmail.com.
authors.forename: Rocio
authors.initials: R
authors.lastname: Garcia-Santibanez
authors.affiliation: Department of Neurology, Mount Sinai Beth Israel, Icahn School of Medicine, New York, NY.
authors.forename: John
authors.initials: J
authors.lastname: Liang
authors.affiliation: Department of Neurology, Mount Sinai Beth Israel, Icahn School of Medicine, New York, NY.
authors.forename: Amy
authors.initials: A
authors.lastname: Walker
authors.affiliation: Department of Neurology, Mount Sinai Beth Israel, Icahn School of Medicine, New York, NY.
authors.forename: Ivan
authors.initials: I
authors.lastname: Matos-Diaz
authors.affiliation: Department of Neurology, Mount Sinai Beth Israel, Icahn School of Medicine, New York, NY.
authors.forename: Kourosh
authors.initials: K
authors.lastname: Kahkeshani
authors.affiliation: Department of Neurology, Mount Sinai Beth Israel, Icahn School of Medicine, New York, NY.
authors.forename: Irene
authors.initials: I
authors.lastname: Boniece
mesh_terms: D059019:Clinical Coding / Q000706:statistics & numerical data; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Stroke code; emergency room; in-hospital; inpatient