If a patient enters Emergency Department with symptoms of stroke with onset more than three hours, or even three or four days prior to ED visit, do the CT and labs need to be performed within the 45 minute timeframe required in the standard?

Any examples are for illustrative purposes only.

Patients who present to the Emergency Department with new onset of stroke symptoms would need to be evaluated to determine the time of symptoms onset or last known well. The organization would define in their Clinical Practice Guidelines using evidence based practices, would identify a window for consideration for treatment with tissue plasminogen activator(t-PA). Patients who present within the treatment window, would activate the Acute Stroke Activation Response and would be required to perform the diagnostic brain image (head CT) completed (and results reported to or reviewed by a member of the stroke team) within 45 minutes of it being ordered, when clinically indicated (in acute hemorrhagic or ischemic stroke resuscitation candidates)."

Acute resuscitation or treatment may include evaluation for use of MERCI retrieval device for ischemic stroke, reversible of coagulopathy, surgical intervention, or blood pressure management as evidenced-based approved modalities for hemorrhagic stroke. If in the judgment of the treating physician(s) it is determined that an expedited CT is not required, the rationale for this decision should be documented in the medical record, and the team should proceed accordingly. However, in the event of unknown time of symptom onset, the recommendation would be to treat the patient as a candidate for IV thrombolytic therapy until such time of symptom onset is known.