Effect of Prehospital Time on Door‐to‐Computed Tomography Time in Acute Ischemic Stroke: A Multicenter Study
Kuo‐En Chen, Po‐Chun Wang, Sheng‐Feng Lin, Hui‐An LinABSTRACT
Objectives
Timely brain imaging is critical for optimizing stroke treatment outcomes. Delays at the prehospital stage significantly impact acute ischemic stroke management. Computed tomography (CT) plays a vital role in guiding treatment decisions.
Methods
We conducted a retrospective observational study using data from the Acute Stroke Statistics System of Taipei City, covering the period from January 1, 2011, to June 30, 2022. The association between prehospital time intervals and door‐to‐CT time was analyzed in patients with acute ischemic stroke. Logistic regression models were applied, with door‐to‐CT time <25 min as the dependent variable. Independent variables included patient characteristics, comorbidities, and prehospital time components: decision‐making time (symptom onset to emergency medical service [EMS] activation), EMS response time, on‐scene time, and transport time.
Results
Among 2351 acute ischemic stroke patients, 1734 patients with complete documentation were included in the final analysis. Factors associated with a door‐to‐CT time >25 min included age ≥85 years (OR: 1.387; 95% CI: 1.025–1.878; p = 0.034), hypertension (OR: 1.412; 95% CI: 1.047–1.905; p <0.001), decision‐making delay (OR: 1.001; 95% CI: 1.001–1.002; p <0.001), and decision‐making delay ≥160 min (OR: 2.340; 95% CI: 1.766–3.099; p <0.001). Prehospital notification was associated with a lower likelihood of delayed imaging (OR: 0.371; 95% CI: 0.266–0.517; p < 0.001). In multivariable analysis, decision‐making delay ≥160 min (OR: 2.279; 95% CI: 1.711–3.036; p <0.001) remained significant determinants of delayed CT imaging, whereas prehospital notification (OR: 0.382; 95% CI: 0.272–0.536; p <0.001) served as a significant protective factor against delayed imaging. A two‐stage pooled analysis across nine advanced emergency responsibility hospitals in Taipei City confirmed these findings with low heterogeneity.
Conclusions
Decision‐making delays and prehospital notification appear to be key determinants of door‐to‐CT time in the management of acute ischemic stroke.