For this retrospective observational study, we included patients evaluated for acute strokes over a one-year period at the CHUM. We extracted and compared data from the archives and the neurovascular database. We compared the median times of management using the chi-square and the Mood test.

363 patients were evaluated for acute stroke and 39 (10.7%) were in-hospital stroke patients. Among intra-hospital strokes, 4 patients had only thrombolysis (10,3%), 4 had only thrombectomy (10,3%) and 1 had both (2.6%). In community-onset, 92 (28.4%) had only thrombolysis, 79 (7.4%) had only thrombectomy and 60 patients had both (18.5%). The median time from detection of symptoms to neurology team activation was 60 minutes for in-hospital stroke (IQR 29-135) and 58 minutes for community-onset stroke (IQR 37-107)(p=0.86). The median time from onset of symptoms to imaging was 94 minutes in-hospital (IQR 48-77) compared to 88 minutes in the emergency department (IQR 65-135)(p=0.245). The thrombolysis administration took 36 minutes from the beginning of in-hospital stroke management (IQR 31-55) and 23 minutes from the beginning of community-onset stroke management (IQR 17-33) (p=0.172).

This study did not reveal any significant differences between the time taken for overall management of hospitalized patient having a stroke compared with community-onset strokes. However, in-hospital delays should be minimal given the fact that patients are already in the institution. Delays in stroke team activation lengthen management. By developing an in-hospital protocol and by sensitizing hospital staff we could potentially offer more acute treatments and improve outcomes.