Article Summary
Placing a CT scanner adjacent to the emergency department reduces stroke imaging times by 3-4 minutes, with median Door-to-CT time dropping from 17 to 14 minutes and Page-to-CT from 10 to 7 minutes, potentially expanding the window for life-saving thrombolytic therapy and mechanical thrombectomy.
- Median Door-to-CT time fell from 17 to 14 minutes after CT scanner relocation adjacent to the ED
- Page-to-CT improved from 10 to 7 minutes across all 522 code stroke and code brain cases studied
- Code stroke patients saw Door-to-CT drop from 16 to 12 minutes and Page-to-CT from 9 to 5 minutes
- All time reductions were statistically significant (p < 0.001 to p = 0.0003)
- American Heart Association guidelines require CT imaging within 25 minutes of ED arrival for acute ischemic stroke
Installing a CT scanner adjacent to the emergency department (ED) can significantly reduce stroke-related imaging times, according to research published July 23 in Clinical Imaging.
The finding is from a retrospective review of 522 code stroke and code brain CT activations and provides the first U.S. data quantifying the effect of scanner relocation on stroke-specific imaging intervals, noted corresponding author Shaveta Khosla, PhD, MPH, of the University of Illinois Chicago, and colleagues.
“The findings of our study support the clinical value of relocating a CT scanner to a location adjacent to the ED by quantifying the extent of impact in critical time metrics,” the group wrote.
In acute ischemic stroke, delays in imaging can narrow or close the window for thrombolytic therapy and mechanical thrombectomy, and American Heart Association/American Stroke Association guidelines call for CT within 25 minutes of ED arrival. While prior studies have examined the effect of CT scanner location on general ED disposition times, none have focused on stroke-specific time metrics, and none have been conducted in the U.S., the researchers noted.
To address the gap, the researchers reviewed time-stamped electronic health records for all code stroke and code brain activations at the medical center between February 1, 2023, and June 30, 2024. Code stroke covered patients within 4.5 hours of symptom onset; code brain covered those between 4.5 and 24 hours. A CT scanner was installed adjacent to the ED on October 16, 2023, splitting the study into pre- and post-intervention periods of roughly 8.5 months each. The team tracked four metrics: Door-to-CT, Page-to-CT (stroke code activation to CT start), Door-to-CT-interpretation, and Page-to-CT-interpretation.
Across all 522 cases (247 pre-installation, 275 post), median Door-to-CT fell from 17 to 14 minutes and median Page-to-CT from 10 to 7 minutes after the scanner move. Median Door-to-CT-interpretation dropped from 31 to 26 minutes, and Page-to-CT-interpretation from 23 to 19 minutes. All overall reductions reached statistical significance (p < 0.001 to p = 0.0003).
Among code stroke patients specifically (n = 318), median Door-to-CT fell from 16 to 12 minutes and Page-to-CT from 9 to 5 minutes, both significant at p < 0.001. For code brain patients (n = 204), median Page-to-CT dropped from 13 to 9 minutes and Page-to-CT-interpretation from 32 to 22 minutes (both p < 0.001).
“These findings underscore the importance of imaging accessibility in time-sensitive conditions like acute stroke, where every minute matters,” the group wrote.
The study did not assess clinical outcomes such as disability, mortality, or treatment rates, and was limited to a single institution, the authors acknowledged. Future research should evaluate whether these time reductions translate into improved treatment rates, hospital length of stay, and functional recovery, the group concluded.
Read the full study here.
