Abstract Body: Introduction: Novel therapies have changed the landscape of acute ischemic stroke (AIS) treatment over the past decade. Timely identification and treatment of AIS is imperative, which makes swift action by emergency departments (ED) critical. Most research on AIS comes from academic medical centers. We sought to report the temporal trends of ED-based AIS treatment from 2012-2022 in a community without an academic medical center.

Methods: As part of the community-based Brain Attack Surveillance in Corpus Christi (BASIC) project, ischemic strokes treated in an emergency department were identified via active and passive surveillance. Logistic regression was used to model the temporal trends for overall neurology consult, tele-stroke consult, NIHSS documentation by provider, transfer to an out of area facility for mechanical thrombectomy, and tPA utilization. All predictions were adjusted for age, race/ethnicity, sex, NIHSS, and history of stroke/TIA. Mechanical thrombectomy candidates were also identified, and frequencies were calculated.

Results: Sample size varied between 3912 and 5156 depending on the outcome and its number of observations with complete covariate data. NIHSS documentation by provider increased by 17.5% (95% CI: 0.135, 0.215) (Figure 1A). Overall neurology consultation rate increased by 25.6% (95% CI: 0.211, 0.302) (Figure 1B). Tele-stroke consult rate increased by 35.7% (95% CI: 0.307, 0.407) (Figure 1C). Patient transfer to an out of area facility for mechanical thrombectomy saw a peak around 2019 (3%) that subsequently declined by 2022 (0.2%) as this expertise became more available in the community (Figure 1D). tPA utilization increased by 6.7% (95% CI: 0.036, 0.098) (Figure 1E). The frequencies of mechanical thrombectomy in 2020, 2021, and 2022 were 2.00%, 4.14%, and 6.68% respectively.

Conclusions: There have been remarkable changes in AIS treatment from the emergency medicine perspective in the last decade. Dramatic increases in neurology and tele-stroke consults, transfers for mechanical thrombectomy, and tPA usage suggests assertive treatment protocols in this “real-world” community without an academic medical center.