National Institutes of Health Stroke Scale and Door to Needle Time Among Veterans Diagnosed with Acute Ischemic Stroke in the VA National Telestroke Program

Research Objectives: To examine the association between National Institutes of Health Stroke Scale (NIHSS) and tissue plasminogen activator (tPA) Door to Needle Time (DTNT) ≤ 45 minutes versus DTNT > 45 minutes among Veterans diagnosed with Acute Ischemic Stroke (AIS) and received telestroke consult.

Design: Cross sectional retrospective analysis of the Veterans Health Administration (VHA) National Telestroke Program (NTSP) data set (2018-2023).

Setting: 55 VHA NTSP sites throughout the United States.

Participants: 448 Veterans diagnosed with AIS, aged 29 years and older, who received tPA treatment through a telestroke consult in the emergency department.

Interventions: N/A

Main Outcome Measures: The primary outcome variable was DTNT ≤ 45 minutes (categorical – yes/no). The primary independent variable was mean NIHSS. Covariate variables considered in the analysis included sociodemographic variables (age, sex, race, rurality) and facility characteristics (complexity status and accept emergency medical services (EMS) via ambulance). Descriptive characteristics were analyzed by Veterans who had DTNT ≤ 45 minutes vs Veterans who had DTNT > 45 minutes using chi-square and t-tests. Multivariable logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for DTNT ≤ 45 minutes and mean NIHSS.

Results: The median age of the sample was 67 years of age (SD ± 13.40) and ranged from 27 to 102 years. The sample included mostly males (92.19%) versus female (7.81%) and lived in urban settings (75.67%) versus rural (24.33%). A larger majority of the samples race was white (71.21%), followed by black (20.76%), and other (8.04%). Thirty-seven Veterans received DTNT ≤ 45 minutes and 411 Veterans received DTNT > 45 minutes. Veterans treated with DTNT ≤ 45 minutes had a significantly higher mean NIHSS (9.14 SD ± 6.73) versus Veterans treated with DTNT > 45 (6.21 SD ± 5.49) (p-value = 0.01). Veterans with higher mean NIHSS had increased odds ratio of DTNT ≤ 45 minutes (OR 1.07, CI 1.02-1.12) and remained significant after controlling for all covariates (OR 1.08, CI 1.03-1.13).

Conclusions: Higher stroke severity (as indicated by the NIHSS) is associated with faster DTNT within the VHA NTSP, and these findings are similar when compared to previous research studies. Additional research is recommended in the NTSP to determine if faster DTNT improve functional outcomes including activities of daily living, functional mobility, and cognition of Veterans with stroke.

Author(s) Disclosures: None