Abstract Body: Introduction: Time from stroke symptom onset to emergency department (ED) arrival (OTA) is an important driver of acute stroke functional outcomes and mortality for both acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH). Acute therapies for AIS are time-sensitive, and there are several recently published time-dependent therapeutic trials for ICH, yet little is known about the patterns of symptom onset to ED presentation over time. We sought to analyze trends and predictors of arrival times for AIS and ICH within the Greater Cincinnati/Northern Kentucky Stroke Study.
Methods: Patients included those ≥20 years old with physician-adjudicated acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH) from 2010, 2015 and 2020. Study nurses abstracted relevant information from the medical record, including symptom onset and ED arrival times. Median OTA time trends were analyzed for both AIS and ICH using quantile regression and the likelihood ratio test for year. Associations between demographic-, clinical-, and system-factors with early OTA times (less than 4.5 hours) were assessed using logistic regression, stratified by AIS and ICH stroke subtype.
Results: There were 6466 AIS events and 950 ICH events among patients ≥20 years old who presented to an ED in the time periods studied. Among all patients with AIS, median age was 70 (IQR 59-82), 23% were black and 54% female, and median NIHSS was 3 (IQR 1-7). Median OTA time for all patients with AIS and onset time known was 483 minutes (IQR 105-1170), 30% arrived with an OTA time ≤4.5 hours, although median OTA times significantly increased over time (Figure 1). Among all patients with ICH, median age was 72 (IQR 58-82), 27% were black and 52% female, and median NIHSS was 7 (IQR 1-22). Median OTA time for patients with ICH and onset time known was 248 minutes (IQR 68-685), 42% arrived with an OTA time ≤4.5 hours, and median OTA times did not significantly change over time. EMS use, presenting symptoms of stroke, and greater stroke severity were associated with better arrival times whereas living alone was associated with worse times (Table 2).
Discussion: Only 33% of AIS and 42% of ICH patients arrive to an emergency department within 4.5 hours of a known symptom onset. Several systems-level factors were associated with onset to arrival times. Understanding why symptom onset to ED arrival times are increasing over time is an important area for quality improvement.