Current literature of in-hospital stroke (IHS) has largely found poor functional outcomes upon discharge and higher mortality with factors such as delayed recognition time and delay in assessment, playing a role in unfavorable outcomes. A resident based acute stroke protocol has been shown to be safe and more efficient, but the literature for IHS patients within teaching hospitals needs better elucidation.

To compare the clinical characteristics, code stroke time metrics, complications and functional outcomes among patients who received intravenous tissue plasminogen activator (IV t-PA) for an ischemic stroke that developed during their hospitalization in a tertiary medical care center with neurology residents versus hospitals without neurology residents.

Using a network database including all in-hospital code strokes, data were retrospectively abstracted between 2010-2018 within a large tertiary hospital with neurology residents (LAMC) and 11 other medical centers (non-LAMC) without neurology residents. Data was analyzed using Wilcoxon Rank Sum Test.

101 patients were identified, 72 at LAMC and 29 at non-LAMC hospitals. There was no difference in baseline characteristics. More patients underwent endovascular intervention, ie. IA t-PA, thrombectomy or both (12.87%) at LAMC compared to non-LAMC (0.99%). There was no difference in the rate of complications between the two groups, though LAMC had 4 patients (3.96%) who developed symptomatic ICH/PH-2 hemorrhage, 3 (2.97%) of which required surgical intervention. Neurology evaluation was quicker at LAMC (15mins, IQR 10 – 27.5mins) vs non-LAMC (27mins, IQR 10 – 50mins) p=0.04. Time from symptom recognition to t-PA administration was shorter at LAMC (67mins, IQR 48.5 – 95.5mins) vs non-LAMC (96mins, IQR 80 – 104min) p=0.001. There was no significant difference in functional outcome, including NIHSS at 24 hours, NIHSS at 3 days and mRS at 90 days.