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

Strbian, Daniel; Michel, Patrik; Ringleb, Peter; Numminen, Heikki; Breuer, Lorenz; Bodenant, Marie; Seiffge, David J; Jung, Simon; Obach, Victor; Weder, Bruno J.; Tiainen, Marjaana; Eskandari, Ashraf; Gumbinger, Christoph; Gensicke, Henrik; Chamorro, Angel; Mattle, Heinrich P.; Engelter, Stefan T.; Leys, Didier; Köhrmann, Martin; Parkkila, Anna-Kaisa; ... (2013). Relationship between onset-to-door time and door-to-thrombolysis time: a pooled analysis of 10 dedicated stroke centers. Stroke, 44(10), pp. 2808-2813. Lippincott Williams & Wilkins 10.1161/STROKEAHA.113.000995

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Jung, Simon; Weder, Bruno J. and Mattle, Heinrich

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0039-2499

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Valentina Rossetti

Date Deposited:

16 Jun 2014 15:23

Last Modified:

09 Dec 2014 11:05

Publisher DOI:

10.1161/STROKEAHA.113.000995

PubMed ID:

23887834

Uncontrolled Keywords:

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

BORIS DOI:

10.7892/boris.53469

URI:

https://boris.unibe.ch/id/eprint/53469

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