Older Stroke Patients with High Stroke Scores Have Delayed Door-To-Needle Times Lee A. Birnbaum, MD, MS,*†‡ Jesse S. Rodriguez, PhD,*‡ Christopher H. Topel, MD,†‡ Reza Behrouz, MD,† Vivek Misra, MD,† Santiago Palacio, MD,† Michele G. Patterson, MSN,‡ Deb S. Motz, BSN,‡ Martin W. Goros, MS,§ John E. Cornell, PhD,§ and Jean-Louis R. Caron, MD*†‡ Introduction: The timely administration of intravenous (IV) tissue plasminogen activator (t-PA) to acute ischemic stroke patients from the period of symptom pre- sentation to treatment, door-to-needle (DTN) time, is an important focus for quality improvement and best clinical practice. Methods: A retrospective review of our Get With The Guidelines database was performed for a 5-hospital telestroke network for the period between January 2010 and January 2015. All acute ischemic stroke patients who were triaged in the emergency departments connected to the telestroke network and received IV t-PA were included. Optimal DTN time was defined as less than 60 minutes. Logistic regression was performed with clinical variables associated with DTN time. Age and National Institutes of Health Stroke Scale (NIHSS) score were categorized based on clinically significant cutoffs. Results: Six- hundred and fifty-two patients (51% women, 46% White, 45% Hispanic, and 8% Black) were included in this study. The mean age was 70 years (range 29-98). Of the variables analyzed, only arrival mode, initial NIHSS score, and the interac- tion between age and initial NIHSS score were significant. DTN time more than or equal to 60 minutes was most common in patients aged more than 80 years with NIHSS score higher than 10. Conclusions: The cause of DTN time delay for older patients with higher NIHSS score is unclear but was not related to pre- senting blood pressure or arrival mode. Further study of this subgroup is important to reduce overall DTN times. Key Words: Acute ischemic stroke—stroke treatment—antithrombotic—tissue plasminogen activator. © 2016 Published by Elsevier Inc. on behalf of National Stroke Association. From the *Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas; †Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, Texas; ‡Baptist Health System, San Antonio, Texas; and §Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Received May 9, 2016; revision received June 26, 2016; accepted July 2, 2016. The Institute for Integration of Medicine and Science (IIMS) funded the statistical analysis. This is the institutional home for the Clinical and Translational Science Award (CTSA) granted to the University of Texas Health Science Center at San Antonio (UTHSCSA) and its partner organizations (5UL1TR001120-03). The project described was supported by the National Center for Advancing Translational Sciences, Nation- al Institutes of Health, through Grant UL1 TR001120. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Data accessibility: All deidentified data are available upon request. Address correspondence to Lee A. Birnbaum, MD, MS, Department of Neurology and Neurosurgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 79229. E-mail: birnbaum@uthscsa.edu. 1052-3057/$ - see front matter © 2016 Published by Elsevier Inc. on behalf of National Stroke Association. http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2016.07.013 ARTICLE IN PRESS Journal of Stroke and Cerebrovascular Diseases, Vol. ■■, No. ■■ (■■), 2016: pp ■■–■■ 1