Abstract P276: The Perception/ Misperception of Treatability of 7AM vs 7PM Stroke Codes

Abstract

\n Background:\n Prior studies have assessed the effect of time of day and day of week on stroke code frequency. Observations that early evening times might result in more treatable stroke cases have been noted. Experiential data raise the question as to whether 7pm codes are often “real” and “intervenable”. Understanding treatment patterns can help allocate resources. We assessed whether 7am early morning stroke code activation resulted in higher yield of acute treatment compared to 7pm evening stroke codes.\n \n \n Methods:\n A retrospective analysis of prospectively collected data from an IRB approved stroke registry, from 7/2004-7/2020, was performed. All patients presenting as a stroke code to our comprehensive stroke center (CSC) or covered hospitals were included. Subjects were divided into 2 groups: (7ASC): Stroke code called 06:00-08:00 and (7PSC) Stroke code called 18:00-20:00. Treatment was defined as receiving any thrombolytic or endovascular intervention. Chi-squared was used for categorical and 2-proportion Z-Test was used for proportional data.\n \n \n Results:\n A total of 988 subjects were identified with stroke codes in these time epochs. Total number of code activations (including mimics) was higher in 7PSC group [277(28.0%) 7ASC, 711(72.0%) 7PSC; p<0.0001] compared to 7ASC group. For patient with final diagnosis of stroke, number of code activations remained higher in 7PSC group [134(28.3%) 7ASC, 340(71.7%) 7PSC; p<0.0001]. Acute treatment rates did not differ between groups [22.7% 7ASC, 22.5% 7PSC; p=0.62].\n \n \n Conclusions:\n We noted more 7PSC stroke codes even when not adjusting for the extended stroke code time windows in later years of the database. We hypothesize that this may be due to more witnesses being available in the early evening. In spite of this finding, acute treatment rates did not differ between times. This data does not support provider perception that early morning codes are unlikely to be “true or treatable” and early evening codes are often “true and treatable”. Irrespective of perception, stroke providers in a CSC must be immediately and equally available in both early morning and evening. This also has ramifications for interventional procedure staffing and clinical trial enrollments. Further analyses in a larger dataset are warranted.\n