In-Hospital Delays in Stroke Thrombolysis: Every Minute Counts.

Abstract

BACKGROUND AND PURPOSE:

Intravenous thrombolysis is a well-established treatment for acute ischemic stroke. Our aim was to quantify the effect of each minute delay in door-to-needle time (DNT) on 90-day survival, intracerebral hemorrhagic complication <36 hours, and functional outcomes at 3 months, in routine clinical practice.

METHODS:

Our nationwide registry-based study included 14 132 adult patient admissions with ischemic stroke receiving intravenous thrombolysis from 2010 to 2017. Outcomes were analyzed using multivariable logistic regression, adjusting for potential confounders.

RESULTS:

Median DNT was 47 minutes, with an improvement from 65 to 38 minutes during the study. Median age was 74 years, and median National Institutes of Health Stroke Scale 8 points. We found a significant impact of each minute delay in DNT with reduced odds of survival by 0.6%, increased odds of intracerebral hemorrhagic and worse activities of daily living by 0.3%, and worse living conditions and mobility by 0.4%.

CONCLUSIONS:

Improving DNT is a key factor in achieving good outcomes after stroke. We estimate that in Sweden alone in 2017, compared with 2010, the shorter DNT achieved have saved 38 lives, avoided 8 intracerebral hemorrhagic transformations, and spared, respectively, 36, 51, and 52 patients from a worsening in activities of daily living, living conditions, and mobility. DNT is sensitive for interventions and should be targeted in quality improvement efforts.

• Authors: David Darehed, Mathias Blom, Eva-Lotta Glader, Johan Niklasson, Bo Norrving, Marie Eriksson
• Journal: Stroke (Stroke) Vol. 51 Issue 8 Pg. 2536-2539 (08 2020) ISSN: 1524-4628 [Electronic] United States
• PMID: 32586222 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Aged, 80 and over
• Cohort Studies
• Female
• Hospitalization (trends)
• Humans
• Male
• Retrospective Studies
• Stroke (diagnosis, epidemiology, therapy)
• Sweden (epidemiology)
• Thrombolytic Therapy (methods, trends)
• Time-to-Treatment (trends)