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From the Duke Clinical Research Institute, Durham, NC (Y.X., X.Z., E.D.P., A.F.H.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology & Neurotherapeutics, Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (D.M.O.); Department of Neurology, University of California, Los Angeles (J.L.S.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Stroke Service, Massachusetts General Hospital, Boston (L.H.S.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).
Published: May 2014
AI Article Synopsis
Article Abstract
Background And Purpose: The benefits of intravenous tissue-type plasminogen activator in acute ischemic stroke are time dependent, and several strategies have been reported to be associated with more rapid door-to-needle (DTN) times. However, the extent to which hospitals are using these strategies and their association with DTN times have not been well studied.
Methods: We surveyed 304 Get With The Guidelines-Stroke hospitals joining
Target: Stroke regarding their baseline use of strategies to reduce DTN times in the January 2008 to December 2009 time frame before the initiation of
Target: Stroke and determined the association between hospital strategies and DTN times.
Results: Among 5460 patients receiving tissue-type plasminogen activator within 3 hours of symptom onset in surveyed hospitals, the median DTN time was 72 minutes (interquartile range, 55-94). Reported use of the different strategies varied considerably. Of 11 hospital strategies analyzed individually by multivariable analysis, 3 strategies were independently associated with shorter DTN times. These included rapid triage/stroke team notification (209/304 [69%] hospitals, 8.1-minute reduction in DTN time), single-call activation system (190/304 [63%] hospitals, 4.3 minutes), and tissue-type plasminogen activator stored in the emergency department (189/304 [62%] hospitals, 3.5 minutes). When analyzed incrementally, hospitals that used a greater number of strategies had shorter DTN times with 1.3 minutes (adjusted mean difference) saved for each strategy implemented (14 minutes if all strategies were used).
Conclusions: Although the majority of participating hospitals reported using some strategy to reduce delays in tissue-type plasminogen activator administration for acute ischemic stroke, the strategies applied vary considerably and those most strongly associated with shorter DTN times were applied relatively less frequently.
