Factors anticipated NIHSS below than 6 following rt-PA treatment 1 hour with acute ischemic stroke: FAIB6

Abstract

In secondary care hospitals lacking mechanical thrombectomy (MT) capabilities, determining the appropriate management strategy, whether to transfer or treat locally, remains a challenge. Waiting for a 24-hour assessment is often too late for effective intervention in non-responders. This study aimed to identify predictors of very early neurological improvement (VENI), defined as an NIHSS score < 6 within 1 hour after intravenous thrombolysis (IV rt-PA), to optimize patient triage, treatment, and referral systems. An ambispective cohort study was conducted on 62 acute ischemic stroke patients treated with IV rt-PA at Kantharalak Hospital. Patients were categorized into two groups based on their 1-hour post-treatment status: "Good Outcome" (NIHSS < 6) and "Poor Outcome" (NIHSS ≥ 6). T-tests, the Shapiro-Wilk test, the Mann-Whitney U test, and univariate and multivariate logistic regression analyses were performed to identify significant predictors.

The results revealed that of the 62 patients, factors significantly associated with good recovery included low baseline severity (Crude OR 0.78, 95% CI 0.68-0.90); absence of Large Vessel Occlusion (No LVO) (Adjusted OR 0.13, p=0.003, 95% CI 0.03-0.50); absence of Atrial Fibrillation (No AF) (Crude OR 0.07, p=0.035, 95% CI 0.00-1.36); and short Door-to-Needle (DTN) time (Adjusted OR 0.95, p=0.005, 95% CI 0.91-0.98).  In conclusion, the predictors associated with excellent early neurological outcomes (NIHSS < 6) within 1 hour after IV rt-PA administration in a nodal community hospital include 1) a low baseline NIHSS score, 2) a short Door-to-Needle (DTN) time, 3) the absence of Large Vessel Occlusion (LVO), and 4) the absence of Atrial Fibrillation (AF). Notably, DTN time represents the most critical systemic factor that community hospitals can optimize to enhance recovery chances. Therefore, for high-risk patients (i.e., those with high NIHSS scores, LVO, or AF), immediate initiation of the referral process ('Drip and Ship') is recommended without awaiting re-evaluation in order to minimize delays in accessing advanced treatment.