Abstract
Introduction: Outcome of acute stroke patients (pts.) treated by thrombolysis is directly related to the door-to-needle time (DNT). We re-organized the management of acute stroke and transfered pts. directly to the CT table in order to reduce DNT. Additionally, the number of stroke mimics was assessed. Methods: DNT of 498 consecutive acute stroke pts. in the 6 hour time window were assessed and compared to the DNT before re-organization. Stroke mimics were assessed by extensive diagnostic work-up. Results: 305/498 (61,4%) pts. submitted by the emergency medical services (EMS) had acute strokes. 59/498 (11,9%) pts. were treated by thrombolysis (19,3% of pts with final diagnosis of stroke) . Mean DNT was 33,7 min. (range 15-70): 22 pts. had a DNT ≤30min, 5 pts. ≤ 20min. and 3 pts. >50min. Direct transfer of pts. to the CT table reduced the DNT from 54min. to 33,7min. 193/498 (38,6 %) pts. submitted with suspected acute stroke were ,,stroke mimics“ . Epileptic seizures and Todd paresis (27%) and electrolyte disorders and infections (16%) were the most frequent final diagnosis. Discussion: A minor change in acute stroke management such as direct transfer to the CT table have major effects on DNT. Education of dispatchers and EMS personnel is important to reduce the number of stroke mimics.
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