Time to Computerized Tomography Scan, Age, and Mortality in Acute Stroke.
BACKGROUND
Time to computerized tomography (CT) is important to institute appropriate and timely hyperacute management in stroke. We aimed to evaluate mortality outcomes in relation to age and time to CT scan.


METHODS
We used routinely collected data in 8 National Health Service trusts in East of England between September 2008 and April 2011. Stroke cases were prospectively identified and confirmed. Odds ratios (ORs) for unadjusted and adjusted models for age categories (<65, 65-74, 75-84, and ≥85 years) as well as time to CT categories (<90 minutes, ≥90 to <180 minutes, ≥180 minutes to 24 hours, and >24 hours) and in-hospital and early (<7 days) mortality outcomes were calculated.


RESULTS
Of the 7693 patients (mean age 76.1 years, 50% male) included, 1151 (16%) died as inpatients and 336 (4%) died within 7 days. Older patients and those admitted from care home had a significantly longer time from admission until CT (P < .001). Patients who had earlier CT scans were admitted to stroke units more frequently (P < .001) but had higher in-patient (P < .001) and 7-day mortality (P < .001). Whereas older age was associated with increased odds of mortality outcomes, longer time to CT was associated with significantly reduced mortality within 7 days (corresponding ORs for the above time periods were 1.00, .61 [95% confidence interval {CI}: .39-.95], .39 [.24-.64], and .16 [.08-.33]) and in-hospital mortality (ORs 1.00, .86 [.64-1.15], .57 [.42-.78] and .71 [.52-.98]).


CONCLUSIONS
Older age was associated with a significantly longer time to CT. However, using CT scan time as a benchmarking tool in stroke may have inherent limitations and does not appear to be a suitable quality marker.
AGEING, Epidemiology Group, School of Medicine & Dentistry, Academic Centre for Applied Clinical & Translational Research into Ageing (ACTRA), University of Aberdeen, Aberdeen, Scotland, United Kingdom. Electronic address: phyo.myint@abdn.ac.uk.
Phyo Kyaw
PK
Myint
Department of Medicine, Gartnavel General Hospital, Glasgow, Scotland, United Kingdom.
Andrew C
AC
Kidd
AGEING, Epidemiology Group, School of Medicine & Dentistry, Academic Centre for Applied Clinical & Translational Research into Ageing (ACTRA), University of Aberdeen, Aberdeen, Scotland, United Kingdom; Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom.
Chun Shing
CS
Kwok
Department of Stroke Medicine, Norwich Medical School, Norwich, United Kingdom.
Stanley D
SD
Musgrave
Stroke Services, James Paget University Hospital, Lowestoft, United Kingdom.
Oliver
O
Redmayne
Stroke Research Group, Norfolk and Norwich University Hospital, Norwich, Norfolk, United Kingdom.
Anthony K
AK
Metcalf
Stroke Services, Ipswich Hospital, Ipswich, United Kingdom.
Joseph
J
Ngeh
Stroke Services, West Suffolk Hospital, Bury St Edmund, United Kingdom.
Anne
A
Nicolson
Stroke Services, Peterborough City Hospital, Peterborough, United Kingdom.
Peter
P
Owusu-Agyei
Stroke Unit, Queen Elizabeth Hospital, King's Lynn, United Kingdom.
Raj
R
Shekhar
Stroke Services, Hinchingbrooke Hospital, Huntingdon, United Kingdom.
Kevin
K
Walsh
Stroke Services, Addenbrooke's University Hospital, Cambridge, United Kingdom.
Diana J
DJ
Day
Stroke Services, Addenbrooke's University Hospital, Cambridge, United Kingdom.
Elizabeth A
EA
Warburton
Stroke Services, James Paget University Hospital, Lowestoft, United Kingdom.
Max O
MO
Bachmann
Stroke Services, James Paget University Hospital, Lowestoft, United Kingdom; Stroke Research Group, Norfolk and Norwich University Hospital, Norwich, Norfolk, United Kingdom.
John F
JF
Potter
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography / Q000379:methods*; D000072226:Computed Tomography Angiography; D057210:Delayed Diagnosis; D004739:England; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D013997:Time Factors; D061665:Time-to-Treatment
Stroke; age; computerized tomography; mortality; outcome