Predictors of rapid brain imaging in acute stroke: analysis of the Get With the Guidelines-Stroke program

Abstract

Background and purpose: National guidelines recommend patients with acute stroke undergo brain imaging within 25 minutes of emergency department arrival. Delayed brain imaging may reduce the effectiveness of thrombolysis or render patients ineligible.

Methods: Data from the Get With The Guidelines-Stroke program from 2003 to 2009 were analyzed to determine overall imaging rates, temporal trends, and predictive variables associated with door-to-imaging times in patients who presented to an emergency department within 2 hours of stroke symptom onset and did not have clear reasons for withholding thrombolysis. Multivariable logistic regression adjusting for within-hospital clustering was performed to identify independent predictors of brain imaging within 25 minutes of emergency department arrival.

Results: Brain imaging was performed within 25 minutes in 41.7% of patients. Rates of imaging within 25 minutes increased from 2003 to 2009 (33.3%-44.5%). In the multivariable model, the following variables were associated with less likelihood of imaging being completed within 25 minutes: age >70 years; female gender; nonwhite race; history of diabetes, peripheral vascular disease, or prosthetic heart valve; transportation other than ambulance; arrival >60 minutes after symptom onset; and hospital location in the Northeast. Patients with National Institutes of Health Stroke Scale scores of 16 to 25 (compared with other strata) were most likely to have imaging completed within 25 minutes.

Conclusions: Most patients with acute stroke symptoms do not have brain imaging performed within the recommended 25 minutes. Future quality improvement initiatives should focus on reducing door-to-imaging times with a specific emphasis on the predictive variables identified in this analysis.