Abstract TP200: Association Between Vascular Trained and Non-Vascular Trained Neurologists in Achieving a 30-Minute Door to Needle Time for Intravenous Thrombolysis in Acute Stroke Patients

Introduction: The benefits of intravenous thrombolysis are time-dependent, and shorter door to needle times have been associated with better outcomes; with the American Heart Association recommending a goal door to needle time of 30 minutes less for at least half of patients. The objective of this study is to identify whether vascular trained neurologists were more likely to achieve a 30-minute door to needle time as opposed to non-vascular trained neurologists. Methods: This was a retrospective, single-center, cohort study of acute stroke patients who received intravenous thrombolysis using data from the electronic medical record and Get with the Guidelines. The neurologist on call was determined to be either a vascular trained or a non-vascular trained neurologist by chart abstraction. Door to needle times were taken from the electronic medical record. Additional information on patient demographics and clinical variables were taken from Get with the Guidelines. Logistic regression was used to model the association between provider training and receipt of thrombolysis within 30 minutes of door to needle time. Results: A total of 164 patients received intravenous thrombolysis between September 2022 to May 2025 with 27 (16.5%) patients receiving thrombolysis within 30 minutes of arrival. Table 1 shows the relationship between patient characteristics and door to needle time. Patients who were non-white, had coronary artery disease, diabetes, or hypertension were less likely to achieve a 30-minute door to needle time. Those who arrived via mobile stroke unit were more likely to achieve a 30-minute door to needle time. Having a vascular trained neurologist on call, and the presence of a large vessel occlusion significantly improved the likelihood of achieving a 30-minute door to needle time (table 2). After adjustment for multiple potential confounders, stroke trained providers were 12.2 times more likely to give thrombolysis within a 30-minute door to needle time (table 3). Conclusion: Among patients being treated for acute ischemic stroke with intravenous thrombolysis, a 30-minute door to needle time was significantly more likely to be achieved when a vascular trained neurologist was on call, as opposed to a non-vascular trained neurologist. Hospitals aiming to achieve better door to needle times could consider having vascular trained neurologists manage clinical decision making in acute stroke patients.