Abstract Body: BACKGROUND: Reperfusion therapies are highly time-sensitive, necessitating streamlined protocols to ensure that each step meets target times. This is especially critical for wake-up strokes where emergent brain magnetic resonance imaging (eMRI-brain) is included in the evaluation process. Stroke alerts, particularly for patients with aphasia or altered mental status, present additional challenges in confirming the absence of metal foreign bodies, leading to time-consuming additional imaging. Implementing protocols that integrate a full-body-scout (FBS) during the non-contrast computed tomography of the head (CT head) could reduce delays and enhance the safety and efficiency of eMRI clearance, thereby improving the likelihood of timely thrombolysis.
OBJECTIVE: To standardize the stroke alert process for eMRI-brain on wake-up stroke cases and reduce door-to-eMRI times in eligible patients by implementing a FBS during CT head (FBS-CT) protocol.
METHODS: We reviewed wake-up stroke alert metrics before and after implementing a FBS-CT protocol between August 01, 2022 and July 31, 2024. The protocol consisted of adding FBS imaging to assess whether the patient had any foreign metal bodies and to avoid the need for additional imaging.
RESULTS: We identified wake-up strokes eligible for thrombolysis from 2,300 stroke alerts reviewed at an academic comprehensive stroke center. We classified the identified cases into two groups: Pre-FBS-CT group (n=53; mean age 58.05± 15.34 ; 66% female; 58% White) and Post-FBS-CT group (n=72; mean age 60.44 ±13.70, 58% female, 72% white). Door-to-eMRI median time was 79 [IQR 50-116] for the Pre-FBS-CT group and 45 [IQR 36.75 -57] min for the Post-FBS-CT group. Thrombolytic was given to only 1 Pre-FBS-CT patient while 12 patients from the Post-FBS-CT group received it.
CONCLUSIONS: Implementing a FBS-CT protocol significantly decreased door-to-eMRI times and reduced the variability in those times. Although we cannot definitively attribute the increased eligibility and administration of thrombolysis solely to the improved imaging times in the Post-FBS-CT group, our data demonstrates a substantial reduction in door-to-eMRI times following protocol implementation. It is important to note that stroke onset may have influenced the presence of DWI-FLAIR mismatch. Nonetheless, any reduction in imaging times is crucial for improving the streamlined process of wake-up stroke alerts and impact patient eligibility for reperfusion therapies.