Abstract T P197

Variation in Last Known Normal Times of Stroke Code Patients

Spokoyny, Ilana
Kim, Alex J
Choe, Jessica S
Raman, Rema
Ernstrom, Karin
Meyer, Brett C
Karanjia, Navaz P

¹Univ of California, San Diego, San Diego, CA
²Univ of California, Los Angeles, Los Angeles, CA

Author Disclosures: I. Spokoyny: None. A.J. Kim: None. J.S. Choe: None. R. Raman: Research Grant; Modest; NIH NS044148. K. Ernstrom: Research Grant; Modest; NIH NS044148. B.C. Meyer: Research Grant; Modest; NIH NS044148. Speakers' Bureau; Modest; Genentech, Boehringer Ingelheim. N.P. Karanjia: None.

Stroke 45(Suppl_1):p AT197, February 2014.

Introduction: Given the time-sensitivity of thrombolytic therapy, the accurate documentation of the patient’s last known normal (LKN) time is crucial to ensure safe and effective management of stroke patients. There exist no studies comparing first recorded LKN times to final verified LKN times. This study investigates whether a difference exists, and the potential impact on treatment and emergent management of acute stroke.

Methods: All stroke code patients evaluated at UCSD hospitals (4/2008-7/2013) with 90 day mRS scores available were included. Electronic chart review was performed to obtain first recorded LKN time. Onset to arrival (OTA) intervals were calculated using both the first recorded LKN and official LKN times. Patients were split into three groups based on the disparity between the OTA intervals. Group A: longer OTA interval using first LKN, Group B: two intervals equal, and Group C: shorter OTA interval using first LKN. These groups were compared by baseline characteristics, rates of tPA administration, 90 day mRS score, and rates of symptomatic ICH.

Results: Of 226 patients included, 74.3% had disparity between first and official LKN time; 16.8% in Group A and 57.5% in Group C. The median discrepancy between the times was 30 minutes for Group A and 45 minutes for Group C. Baseline characteristics were not significantly different between groups. In stroke/TIA patients, rates of tPA administration were significantly different (A: 65.4%, B: 39.5%, C: 34.8, p=0.022). In Group A, 62.5% had 90 day mRS of 0-1, versus 50% of Group B and 34.4% of Group C, without significant difference. There were no symptomatic ICHs in Group A, compared to 1 (5.6%) in Group B and 3 (9.1%) in Group C.

Conclusions: There was a significant proportion of patients with disparity between the first and official recorded LKN times, with the majority falling into Group C (shorter OTA interval using first LKN). If this first recorded time were used to make treatment decisions, as may be the case at community hospitals without stroke neurologists, patients may be frequently treated outside of the recommended window, with a higher risk of adverse safety outcomes. This study highlights the need for accurate determination of last known normal time in order to make the proper treatment decisions.