Prehospital intravenous access is associated with decreased door-to-computed tomography and door-to-intravenous thrombolysis time, but not door-to-endovascular therapy time

Introduction Prehospital stroke care can influence in-hospital stroke care, including facilitating earlier diagnosis and treatment. This study sought to determine the association between prehospital IV access and time to computed tomography (CT), intravenous (IV) thrombolytic administration, and endovascular therapy in patients with stroke. Methods This was a multi-institutional, multi-agency retrospective analysis of patients who were identified as having stroke-like presentations by emergency medical services (EMS) and had a final clinical diagnosis of stroke or transient ischemic attack (TIA) from January 1, 2020, to December 31, 2022. Data were analyzed using descriptive statistics and multivariable linear regressions controlling for receiving hospital stroke certification level, sex, age, initial NIHSS score, hospital prenotification of suspected stroke, and EMS-documented blood glucose level, stroke scale, and last known well (LKW) time. Results Of the 3,109 patients in the study, 91.2% ( n = 2,834) arrived with IV access obtained from EMS. Patients who arrived with IV access had a median door-to-CT time of 10 min interquartile range (IQR) 7–16 min compared to those without IV access who had a median door-to-CT time of 12 min (IQR 8–21 min; p 0.05). After adjusting for covariates, arrival without IV access increased the door-to-CT time by 26% ratio estimate 1.26, 95% confidence interval (CI), 1.14–1.39 compared to those with IV access. Similarly, after controlling for covariates, lack of prehospital IV access was associated with increased time to intravenous thrombolysis (IVT; ratio estimate 1.17, 95% CI, 1.01–1.36), but not with time to endovascular thrombectomy (EVT; ratio estimate 1.05, 95% CI, 0.82–1.33) compared to those with prehospital IV access. Conclusion EMS insertion of an IV prior to hospital arrival was associated with shorter time to imaging and shorter time to intravenous thrombolysis but was not associated with a difference in time to endovascular thrombectomy.