Abstract TMP14: Should 45-Minute Door to Needle Time be the New Standard of Care? Analysis of Categorized Treatment Time in a Large, Multi-hospital Registry

Abstract

Introduction: With the introduction of American Stroke Association’s Target Stroke and Target Stroke2, hospitals have emphasized faster door to needle time (DTN) for acute ischemic stroke based on criteria of less than 60 minutes and less than 45 minutes, but little is known about its impact on outcomes. In this study, we evaluated outcomes based on similarly categorized treatment times across a large multi-hospital system in the Pacific Northwest. Methods: Data obtained from a multi-hospital health system’s Get With The Guidelines registry included patients discharged between January 2011 and June 2016 and treated with IV alteplase. Primary outcomes were discharge disposition, modified Rankin score (mRS) at discharge and 90-days, disability categorized as none/slight (mRS≤2) and moderate or greater (mRS ≥3) and treatment-related hemorrhagic complications. DTN was categorized into three groups: <45 minutes, 45-60 minutes, or >60 minutes. Generalized linear mixed regression models were used to analyze the effect of DTN group on outcomes after adjusting for the following covariates: admit NIHSS score, gender, age, last known well to arrival time, intra-arterial intervention, and history of co-morbid conditions. Adjusted odds ratios (AOR) and p-values were reported. Results: A total of 2,434 patients met inclusion criteria. DTN times were broken down as follows: 25% percent (n=610) of patients were < 45 minutes, 28.1% (n=684) were 45-60 minutes and 46.8% (n=1140) were > 60 minutes. Patients with DTN > 60 minutes were more likely than patients with DTN < 45 minutes to have moderate or greater disability at 90 days (AOR=2.43; p=.042), have a treatment-related hemorrhage (AOR=2.00; p=.045), be discharged to a skilled nursing facility or inpatient rehab versus home (AOR=2.29; p=.022), or be discharged to hospice or expired versus home (AOR=2.47; p=.014). Patients with DTN between 45 and 60 minutes were also more likely than patients with DTN < 45 minutes to be discharged to hospice or expired versus home (AOR=3.21;p=.022). There was no significant effect of DTN on discharge mRS (p=.691). Conclusion: DTN time less than 45 minutes is associated with reduced mortality, less severe disability, fewer hemorrhagic complications and higher rates of home discharge.