Abstract TP361: Implementation of a 24-Hour Stroke Code Window Does Not Impact Stroke Code Volume or Yield

Objective: To assess for changes in stroke code volume and yield after implementation of an extended 24-hour acute stroke code window (ASCW). Background: The DAWN and DEFUSE-3 trials showed that extended time windows of 16 to 24 hours benefit select patients with confirmed large vessel occlusion (LVO) of the anterior circulation. The Mount Sinai Hospital emergency department (MSH ED) extended its ASCW from 12 to 24 hours in anticipation of those results. Methods: We retrospectively analyzed de-identified data collected for patients presenting to the MSH ED as stroke codes, estimated by the number of acute stroke non-contrast head CT scans performed. We compared last known well (LKW)-to-arrival time, door-to-CT time, ancillary imaging, and intervention status seven months prior to (baseline cohort), and following (intervention cohort), implementation of the 24-hour ASCW. This work was part of a departmental quality improvement project to optimize local policy in the context of new acute stroke treatment guidelines. Results: Baseline cohort: 197 stroke codes were called. Median NIHSS was 7. 27 (14%) presented after 12 hours. Median LKW-to-arrival was 212 minutes and median door-to-CT was 22 minutes. 136 (69%) received a CT angiogram (CTA) and 32 (16%) received CT perfusion (CTP). 25 (13%) were treated with intravenous alteplase (IV tPA). 44 (22%) underwent mechanical thrombectomy (MT) with a median LKW-to-arrival of 209 minutes. Intervention cohort: 200 acute stroke codes were called. Median NIHSS was 6. 58 (29%) presented after 12 hours. Median LKW-to-arrival was 280 minutes, and median door-to-CT was 19 minutes. 135 (68%) received CTA and 27 (14%) received CTP. 36 (18%) were treated with IV tPA. 43 (22%) underwent MT with a median LKW-to-arrival of 283 minutes. Conclusions: The number of stroke codes called with an extended 24-hour ASCW remained stable. Although the number of patients presenting after 12 hours more than doubled, there was no increase in the number of patients who underwent MT. This likely reflects the practice that stroke codes are called whenever there is a high suspicion for LVO regardless of the determined ASCW, so that the change to 24-hour ASCW did not significantly impact demand and work flow.