Abstract
ObjectivesRapid initiation of intravenous thrombolysis improves patient’s outcome in acute stroke. We analyzed inter-center variability and factors that influence the door-to-needle time with a special focus on process measurements in all Austrian stroke units.MethodsCase level data of patients receiving intravenous thrombolysis in the Austrian Stroke Unit Registry were enriched with information of a structured questionnaire on center specific process measures of all Austrian stroke units. Influence of case and center specific variables was determined by LASSO procedure.ResultsCenter specific median door-to-needle time ranged between 30 and 78 minutes. Between April 2004 and November 2012, 6246 of 57991 patients treated in Austrian stroke units with acute ischemic stroke received intravenous thrombolysis. An onset-to-door time >120 minutes, patients with total anterior circulation stroke, recent year of admission, patient transportation with ambulance crew and emergency physician, the use of point of care tests reduced the door-to-needle time, whereas onset-to-door ≤60 minutes, unknown onset-to-door, patients with an NIHSS ≤4 or posterior circulation stroke, initial admission to a general emergency department, a distant radiology department, primary imaging modality other than plain CT and waiting for the lab results were associated with an increase in door-to-needle time. Case level and center specific factors could explain the inter center variability of door-to-needle times in 31 of 34 stroke units in Austria.ConclusionsIn light of our results it seems crucial that every single stroke center documents and critically reviews possibilities of optimizing practice strategies in acute stroke care.
Highlights
Intravenous recombinant tissue plasminogen activator is the gold standard therapy for acute ischemic stroke. [1,2,3] It can only be applied up to 4.5 hours within the onset of stroke symptoms [3] and a short onset-to-treatment time (OTT) translates into a better functional outcome [4]
Both evaluations demonstrated a high variability between different centers in reaching this goal ranging between 0% to 84%. [6,7] Our own previous analysis of the Austrian Stroke Unit Registry [8] as well as other evaluations have described multiple factors increasing the door-to-needle time (DNT) like older age, female sex, black race, low or very high stroke severity, presence of prior stroke, short onset-to-door time (ODT) and performing angiography or perfusion imaging prior to thrombolysis [6,7]
Between April 2004 and November 8th 2012, a total of 57991 patients with an acute ischemic stroke were treated in Austrian stroke units. 7498 (13%) of them received a therapy with intravenous thrombolysis
Summary
Intravenous recombinant tissue plasminogen activator (rtPA) is the gold standard therapy for acute ischemic stroke. [1,2,3] It can only be applied up to 4.5 hours within the onset of stroke symptoms [3] and a short onset-to-treatment time (OTT) translates into a better functional outcome [4]. [5] Still recent evaluations in the US (Get With The Guidelines Stroke national United States Registry, GWTG-Stroke) [6] and in Eastern European Countries [7] (Safe Implementation of Treatments in Stroke – East Registry, SITS-EAST) have shown only 26.6% and 38% of patients are treated with iv thrombolysis with a DNT below 60 minutes as recommended by national guidelines Both evaluations demonstrated a high variability between different centers in reaching this goal ranging between 0% to 84%. [6,7] Our own previous analysis of the Austrian Stroke Unit Registry [8] as well as other evaluations have described multiple factors increasing the DNT like older age, female sex, black race, low or very high stroke severity, presence of prior stroke, short ODT and performing angiography or perfusion imaging prior to thrombolysis [6,7] All these factors fail to explain the high inter-center variability. All these factors fail to explain the high inter-center variability. [6,7] As possible cause differences in stroke management within stroke centers and countries have been proposed. [7] In order to further explore factors that influence the DNT with a special focus on process measurements we supplemented the extensive hospital and case level data (like for example age, sex, clinical syndrome or National Institutes of Health Stroke Scale score (NIHSS)) of the Austrian stroke unit registry with information of a structured questionnaire on process measures in all stroke units in Austria
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
