Question: Time Last Known Well is after hospital arrival

Pt Arrived 7/1@ 1520 Dx Hyponatremia. No neuro defecits. 7/2 @0000 pt eating supper, ambulating & talking to nurse. 7/2 @0030 pt call light on, nurse goes to bedside and finds pt non-verbal and follows some commands. NIHSS=14. Neurologists saw pt who met tPA criteria. TPA started 7/2 @ 0257. As an in-pt stroke is there any reason based on the timing of stroke onset to exclude this case?

Answer:

STK-4 Thrombolytic Therapy is constructed to capture in the denominator population only those patients who stroke prior to hsoptial arrival. Date/Time Last Known Well must be prior to Arrival Date/Time in order to meet the 2 hour timeframe for inclusion in the STK-4 denominator.

Although the care of those patients who stroke after hospital arrival is similar, patients with stroke symptom onset after hospital arrival are not included in the STK-4 measure population. The Timing I computation in the STK-4 algorithm will exclude cases that have a Date/Time LKW after hospital arrival.