{
  "abstract": "Background Rapid treatment is essential in acute ischemic stroke, as delays in reperfusion are associated with worse neurological outcomes. Patients frequently present first to peripheral stroke centers, where multiple workflow steps, including prehospital transport, initial evaluation, imaging, and transfer decisions, may contribute to treatment delays. Identifying the phases of care that most significantly prolong total ischemic time is critical for improving stroke system efficiency.Methods We conducted a retrospective study of prospectively collected registry data (January 2020-August 2024) from two comprehensive stroke centers within a unified United States stroke network. The study included adult patients with anterior circulation large vessel occlusion who received intravenous thrombolysis (IVT) within 4.5 hours of last known well (LKW) and were referred from peripheral stoke centers. The primary metric was LKW-to-needle time. Sequential component intervals (LKW-to-door, door-to-CT head, CT-to-IVT) were analyzed as absolute durations and as proportional contributions to total workflow time. Prolonged cases were defined as ≥90th percentile of cohort distribution LKW-to-needle time.Results Among 168 eligible patients (median age 71 years; 48.2% female; median NIHSS 16). The median LKW-to-needle was in 225 minutes (IQR 215 - 236) prolonged cases versus 105 minutes (IQR 84.5 - 135.5; p<0.001). Prolonged LKW-to-needle time was driven predominantly by LKW-to-door transfer intervals. Patients in the prolonged group had significantly longer LKW-to-door times (168 vs. 60 minutes; p<0.001). Door-to-CT head duration did not differ significantly in absolute minutes between groups but represented a smaller proportional contribution to the total workflow time in prolonged cases (5.2% vs. 8%; p=0.03). CT-to-IVT time was significantly extended in prolonged cases (43 vs. 34 minutes; p<0.001) and accounted for (17.7% vs. 32.3%; p=0.002) of total workflow times between groups.Conclusions Among patients with anterior circulation stroke presenting to peripheral stroke centers, LKW to door appears to be the primary contributor to prolonged care timelines in this study. This interval may be confounded by variability between actual symptom onset and emergency medical service activation. Further studies are needed to better characterize true transport and prehospital delays. Nevertheless, optimizing prehospital triage and transport protocols may offer the greatest opportunity to reduce total ischemic time within this care model.Disclosures K. Darko: None. V. Bohl: None. C. Schirmer: None.Abstract P-015 Figure 1",
  "authors": [
    {
      "affiliations": [
        "Geisinger Medical Center, Danville, PA"
      ],
      "name": "K Darko"
    },
    {
      "affiliations": [
        "Geisinger Commonwealth School of Medicine, Scranton, PA"
      ],
      "name": "TM Bielinski"
    },
    {
      "affiliations": [
        "School of Medicine, Geisinger College of Health Sciences, Scranton, PA"
      ],
      "name": "KE Kline"
    },
    {
      "affiliations": [
        "Geisinger Commonwealth School of Medicine, Scranton, PA"
      ],
      "name": "V Bohl"
    },
    {
      "affiliations": [
        "Neurosurgery, Geisinger Health, Danville, PA"
      ],
      "name": "O Goren"
    },
    {
      "affiliations": [
        "Geisinger Medical Center, Danville, PA"
      ],
      "name": "C Schirmer"
    },
    {
      "affiliations": [
        "Geisinger Medical Center, Danville, PA"
      ],
      "name": "P Hendrix"
    }
  ],
  "title": "P-015 Evaluating last known well to needle delays: a temporal analysis of patients presenting to peripheral stroke centers",
  "uid": "33715b15-80ef-5f12-babd-4c2cede6d972"
}