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Stroke. 2013 Oct;44(10):2808-13. doi: 10.1161/STROKEAHA.113.000995. Epub 2013 Jul 25.

Relationship between onset-to-door time and door-to-thrombolysis time: a pooled analysis of 10 dedicated stroke centers.

Author information

1
From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., M.T., T.T.); Department of Neurology and Stroke Unit, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland (P.M., A.E.); Department of Neurology and Stroke Unit, University of Heidelberg, Heidelberg, Germany (P.R., C.G., W.H.); Department of Neurology and Stroke Unit, Tampere University Hospital, Tampere, Finland (H.N., A.-K.P.); Department of Neurology and Stroke Unit, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology and Stroke Unit, University Lille Nord de France (M.B., D.L.); Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (D.J.S., H.G., S.T.E.); Department of Neurology and Stroke Unit, University of Bern, Bern, Switzerland (S.J., B.W., H.P.M.); Department of Neurology and Stroke Unit, Hospital Clínic Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain (V.O., A.C.); and Department of Neurology and Stroke Unit, Kantonsspital St. Gallen, St. Gallen, Switzerland (B.W.).

Abstract

BACKGROUND AND PURPOSE:

Inverse relationship between onset-to-door time (ODT) and door-to-needle time (DNT) in stroke thrombolysis was reported from various registries. We analyzed this relationship and other determinants of DNT in dedicated stroke centers.

METHODS:

Prospectively collected data of consecutive ischemic stroke patients from 10 centers who received IV thrombolysis within 4.5 hours from symptom onset were merged (n=7106). DNT was analyzed as a function of demographic and prehospital variables using regression analyses, and change over time was considered.

RESULTS:

In 6348 eligible patients with known treatment delays, median DNT was 42 minutes and kept decreasing steeply every year (P<0.001). Median DNT of 55 minutes was observed in patients with ODT ≤30 minutes, whereas it declined for patients presenting within the last 30 minutes of the 3-hour time window (median, 33 minutes) and of the 4.5-hour time window (20 minutes). For ODT within the first 30 minutes of the extended time window (181-210 minutes), DNT increased to 42 minutes. DNT was stable for ODT for 30 to 150 minutes (40-45 minutes). We found a weak inverse overall correlation between ODT and DNT (R(2)=-0.12; P<0.001), but it was strong in patients treated between 3 and 4.5 hours (R(2)=-0.75; P<0.001). ODT was independently inversely associated with DNT (P<0.001) in regression analysis. Octogenarians and women tended to have longer DNT.

CONCLUSIONS:

DNT was decreasing steeply over the last years in dedicated stroke centers; however, significant oscillations of in-hospital treatment delays occurred at both ends of the time window. This suggests that further improvements can be achieved, particularly in the elderly.

KEYWORDS:

door-to-needle time; emergencies; ischemic stroke; outcome; thrombolysis

PMID:
23887834
DOI:
10.1161/STROKEAHA.113.000995
[Indexed for MEDLINE]
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