Effect of time tracking on speed of tissue-type plasminogen activator treatment in patients with acute ischemic stroke

Abstract

Objective To explore the effect of time tracking on speed of tissue-type plasminogen activator treatment in patients with acute ischemic stroke, and the correlation between door to needle time (DNT) and onset to door time (ODT). Methods Time tracking tables had been prospectively collected since October 2012. The data of intravenous thrombolytic candidates with acute ischemic stroke were retrospectively reviewed from June 2009 to September 2013. Baseline characteristics and the correlation between ODT and DNT were assessed respectively before and after the implementation of time tracking. Results Three hundred and forty-two cases were finally included. Before the implementation of time tracking, ODT was negatively correlated with DNT（r=-0.169，P=0.015）;Patients with transient ischemic attack (TIA)/stoke history(β=-0.168, P=0.020）and ODT (β=-0.246, P=0.001) accounted for the length of DNT independently. Since the implementation of time tracking, the elderly accounted for more (19.4%(25/129) vs 10.3%(22/213); χ2=5.552, P=0.018), the baseline nervous impairment was NIHSS scores (milder 11.0±6.3 vs 12.5±6.7; t=2.065, P=0.040), the proportions of patients taking multi-modality imaging were larger (63.6%(82/129) vs 51.6%(110/213);χ2=4.638, P=0.031) and the DNT decreased significantly ((87.6±33.2) min vs (108.4±52.4) min;t=4.274, P=0.000),which was especially seen in patients arrived within 1 hour after onset ((90.3±21.0) min vs (132.5±46.0） min; t=5.048, P=0.000), and the previous inversely correlated DNT and ODT (r=-0.169,P=0.015) became irrelevant (r=-0.013, P=0.885). Conclusion Implementation of time tracking reduces DNT, and clears up the effect of ODT on DNT. Key words: Brain ischemia; Stroke; Thrombolytic therapy; Time factors