title: Older Stroke Patients with High Stroke Scores Have Delayed Door-To-Needle Times.
abstract: BACKGROUND
  The timely administration of intravenous (IV) tissue plasminogen activator (t-PA) to acute ischemic stroke patients from the period of symptom presentation to treatment, door-to-needle (DTN) time, is an important focus for quality improvement and best clinical practice.
  
  
  METHODS
  A retrospective review of our Get With The Guidelines database was performed for a 5-hospital telestroke network for the period between January 2010 and January 2015. All acute ischemic stroke patients who were triaged in the emergency departments connected to the telestroke network and received IV t-PA were included. Optimal DTN time was defined as less than 60 minutes. Logistic regression was performed with clinical variables associated with DTN time. Age and National Institutes of Health Stroke Scale (NIHSS) score were categorized based on clinically significant cutoffs.
  
  
  RESULTS
  Six-hundred and fifty-two patients (51% women, 46% White, 45% Hispanic, and 8% Black) were included in this study. The mean age was 70 years (range 29-98). Of the variables analyzed, only arrival mode, initial NIHSS score, and the interaction between age and initial NIHSS score were significant. DTN time more than or equal to 60 minutes was most common in patients aged more than 80 years with NIHSS score higher than 10.
  
  
  CONCLUSIONS
  The cause of DTN time delay for older patients with higher NIHSS score is unclear but was not related to presenting blood pressure or arrival mode. Further study of this subgroup is important to reduce overall DTN times.
authors.affiliation: Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Baptist Health System, San Antonio, Texas. Electronic address: birnbaum@uthscsa.edu.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Birnbaum
authors.affiliation: Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Baptist Health System, San Antonio, Texas.
authors.forename: Jesse S
authors.initials: JS
authors.lastname: Rodriguez
authors.affiliation: Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Baptist Health System, San Antonio, Texas.
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Topel
authors.affiliation: Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Reza
authors.initials: R
authors.lastname: Behrouz
authors.affiliation: Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Vivek
authors.initials: V
authors.lastname: Misra
authors.affiliation: Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Santiago
authors.initials: S
authors.lastname: Palacio
authors.affiliation: Baptist Health System, San Antonio, Texas.
authors.forename: Michele G
authors.initials: MG
authors.lastname: Patterson
authors.affiliation: Baptist Health System, San Antonio, Texas.
authors.forename: Deb S
authors.initials: DS
authors.lastname: Motz
authors.affiliation: Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Martin W
authors.initials: MW
authors.lastname: Goros
authors.affiliation: Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: John E
authors.initials: JE
authors.lastname: Cornell
authors.affiliation: Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, Texas; Baptist Health System, San Antonio, Texas.
authors.forename: Jean-Louis R
authors.initials: JR
authors.lastname: Caron
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D019983:Guideline Adherence; D054625:Healthcare Disparities / Q000592:standards; D006801:Humans; D007262:Infusions, Intravenous; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D013781:Texas; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000592:standards; D013997:Time Factors; D061665:Time-to-Treatment / Q000592:standards; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator
keywords: Acute ischemic stroke; antithrombotic; stroke treatment; tissue plasminogen activator