CHICAGO, Dec. 2 -- Bringing the CT to the stroke patient, rather than the other way round, dramatically reduced door-to-scan time in a community hospital, researchers said here.
But despite the use of a portable CT, which expedited the time to a scan, only about 1% of ischemic stroke patients beat the three-hour window for the use of thrombolysis.
That finding emerged from a study that gauged the impact of adding an eight-slice, portable head-and-neck CT scanner to the emergency department at a 280-bed community hospital -- a hospital in which the radiology department was housed in a different building than the emergency department.
Action Points
- Explain to interested patients that time is critical in treatment of ischemic stroke because thombolytic therapy must be initiated within three hours of symptom onset.
- Explain to interested patients that this single-center study found that use of a portable head-and-neck CT scan reduced door-to-scan time, but most patients still failed to meet the three-hour treatment window.
- This study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
When the portable CT scan was available for use during the 3 p.m. to 11 p.m. shift, suspected stroke patients were scanned in an average of 16 minutes versus the average of 39 minutes that it took to transport them to the radiology department (P<0.001), said David B. Weinreb, M.D., who conducted the study while training at North Shore Medical Center-Salem Hospital in Salem, Mass.
Dr. Weinreb, now a radiology resident at Saint Raphael Hospital in New Haven, Conn., discussed the five-month long portable CT study at the Radiological Society of North America meeting.
Using a computer model to assess the effect of the portable unit, Dr. Weinreb calculated that using stationary CT scans in the radiology department meant that about one in 170 stroke patients would be eligible for tPA -- meaning they would have arrived at the hospital and completed assessment in less than three hours from the onset of stroke symptoms.
The same computer model estimated that with a portable unit, "about one in 91 patients or 1.1% would be eligible for tPA," Dr. Weinreb said.
Over the five month course of the study about 530 stroke patients were admitted to the emergency department, "but because we used the portable unit on only one shift, less than half of those patients were assessed using the unit," Dr. Weinreb said.
Which is why Dr. Weinreb fed the average door-to-scan data into the computer model to calculate the estimated impact of a bedside scanner.
The raw data -- stroke patients evaluated and treated -- revealed that only 20 patients had tPA during the five months.
Philip O. Alderson, M.D., dean of Saint Louis University, said it was difficult to estimate the impact of such scanners. He noted, for example, that most emergency departments have at least one scanner available in the department or in very close proximity -- not in an adjacent building.
Moreover, he said that the presence of a portable scanner still did not guarantee that it would be available to assess a suspected stroke case. "Even with a head-only scanner, it could be in use for evaluation of head trauma," Dr. Alderson said.
And finally, both Dr. Alderson and Dr. Weinreb said that while shaving minutes from the door-to-scan time was helpful, the real issue with stroke is timely arrival at the hospital.
Too often, Dr. Alderson said, patients arrive at the hospital complaining that symptoms started the previous night.
| The study was investigator initiated and funded by the institution.
Dr. Alderson disclosed no financial conflicts. Dr. Weinreb said he received travel expenses and consulted as medical writer for Neurologica, the company that makes the portable scanner. |