Door-to-needle time (DTN) is associated with outcomes in acute ischemic stroke (AIS) patients, who are eligible to receive intravenous tissue plasminogen activator (IV tPA). Various factors have been shown to impact DTN time including patient-related factors such as management of hypertension on admission; hospital-related factors such as time-to-imaging; and system-related factors, all potentially affecting clinical outcomes. 

This was a retrospective chart review of prospectively collected data through Get-with-the-Guidelines from Jan-2015 to Dec-2018 at our comprehensive stroke center. Patient demographics, medical history including vascular risk factors, last known well time, arrival time, door-to-CT time, treatment time, admission National Institutes of Health stroke scale (NIHSS), pre-stroke modified Rankin scale (mRS) were analyzed. We analyzed two groups based on presence or absence of major hemispheric cortical sign(s) (aphasia and/or hemineglect) at presentation. The Kruskal-Wallis test was used to analyze continuous variables, and Fisher’s exact test for categorical variables.  

Of 280 patients (mean age 72; 51% men) who received IV tPA in the emergency department (ED), 49.6% presented with at least one cortical sign. Patients in this group were older (79 vs 69 years, p<0.0001) and were more frequently women (57%, p=0.003). These patients had a higher NIHSS (11 vs. 3, p<0.0001), which is expected as an inherent imperfection of the scale. Median DTN time (45 vs. 43 minutes, p=0.92), Onset-to-treatment (OTT) times (145 vs. 150 minutes, p=0.51), and proportion of patients treated within 45 minutes (p=0.41) or 60 minutes (p=0.41) did not differ between the groups.

In our AIS patient population, major hemispheric cortical sign(s) at presentation did not impact DTN times. Nonetheless, cortical deficits are just one example of “non-traditional” factors  which can potentially impact DTN times and subsequent clinical outcomes.