Abstract 62: The Need For Speed- Treating Stroke In Thegolden Hour Ina Large Community Cohort

Background: Acute stroke treatment with IV thrombolysis is time dependent and most effective within the first hour of symptom onset, the “golden hour”. We evaluated the rate of treatment within the golden hour in our system. Methods: We included all potential strokes arriving by ambulance who were treated with intravenous thrombolysis at 21 Kaiser Permanente Northern California stroke centers from 1/1/19 to 8/31/20. All patients were evaluated by teleneurologists on arrival. Assessment included demographics, mode of arrival, initial NIHSS, door-to-needle (DTN) and door-in-door-out times, large vessel occlusion (LVO), discharge outcomes. Bivariate analysis and multivariate models were used to assess percent with Modified Rankin Scale (mRS) 0 to 2, and 90-day mortality for patients treated within the golden hour compared to outside that window. Results: Among 1056 patients in the study cohort, 148 (14%) were treated in the golden hour. Rate of treatment within the golden hour varied greatly by facility (5-21%). These patients had higher initial NIHSS, lower DTN times, more LVO, and a trend for better 90-day mRS 0-2 (Table). Multivariate model revealed lower 90-day mortality among those treated during the golden hour (OR=0.44, 95% CI 0.25-0.77, p= 0.004). The success rate of being able to treat within 60 minutes of symptom onset was primarily dependent on the percentage of patients arriving at the hospital within 40 minutes of symptom onset rather than any differences in speed of treatment after arrival. Conclusions: Patients treated within the golden hour had higher NIHSS, faster treatment, lower mortality, and a trend toward better favorable mRS. Given that the main determinant of golden hour treatment was how quickly patients arrived at the emergency department, further public education to call 911 is needed and EMS agencies should optimize prehospital stroke evaluation in favor of rapid transport.