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

Details

Serval ID
serval:BIB_E8CE2009691A
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Relationship between onset-to-door time and door-to-thrombolysis time: a pooled analysis of 10 dedicated stroke centers.
Journal
Stroke; A Journal of Cerebral Circulation
Author(s)
Strbian D., Michel P., Ringleb P., Numminen H., Breuer L., Bodenant M., Seiffge D.J., Jung S., Obach V., Weder B., Tiainen M., Eskandari A., Gumbinger C., Gensicke H., Chamorro A., Mattle H.P., Engelter S.T., Leys D., Köhrmann M., Parkkila A.K., Hacke W., Tatlisumak T.
ISSN
1524-4628 (Electronic)
ISSN-L
0039-2499
Publication state
Published
Issued date
2013
Peer-reviewed
Oui
Volume
44
Number
10
Pages
2808-2813
Language
english
Notes
Publication types: Clinical Trial ; Journal Article ; Multicenter StudyPublication Status: ppublish
Abstract
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.
Keywords
Age Factors, Aged, Aged, 80 and over, Delivery of Health Care/standards, Europe, Female, Hospitalization, Hospitals, Special, Humans, Male, Middle Aged, Sex Factors, Stroke/therapy, Thrombolytic Therapy/methods, Thrombolytic Therapy/standards, Time Factors
Pubmed
Web of science
Open Access
Yes
Create date
18/10/2016 13:36
Last modification date
20/08/2019 16:11
Usage data