论文信息 - Door-to-Needle Times: Let's Not Leave Smaller Hospitals Behind.

Door-to-Needle Times: Let's Not Leave Smaller Hospitals Behind.

See related article, p 1275. In this issue of Stroke, Strbian et al1 present disappointing data on door-to-needle times (DNTs) for tissue-type plasminogen activator (tPA) from the Safe Implementation of Thrombolysis in Stroke (SITS) registry. Not only was the median DNT 67 minutes long, but also there was little overall change from 2003 to 2011 (see Figure 1 of Strbian et al1). This means that more than half of patients were treated >60 minutes after emergency department arrival, an unacceptably long interval. DNTs in North America in this time period were slightly longer. In the US national Get With The Guidelines-Stroke (GWTG-Stroke) database, median DNT from 2003 to 2009 was 78 minutes.2 In the Registry of the Canadian Stroke Network, median DNT from 2008 to 2009 was 72 minutes.3 However, hidden within these overall disappointing data there is a glimmer of hope. The largest volume hospitals in SITS, treating >75 to 100 patients …

Eric E. Smith

[1] I. Surakka,et al. Trends in Door-to-Thrombolysis Time in the Safe Implementation of Stroke Thrombolysis Registry: Effect of Center Volume and Duration of Registry Membership , 2015, Stroke.

[2] Adrian F Hernandez,et al. Strategies Used by Hospitals to Improve Speed of Tissue-Type Plasminogen Activator Treatment in Acute Ischemic Stroke , 2014, Stroke.

[3] Eric E. Smith,et al. Door-to-needle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quality improvement initiative. , 2014, JAMA.

[4] Atte Meretoja,et al. Reducing in-hospital delay to 20 minutes in stroke thrombolysis , 2012, Neurology.

[5] Eric E. Smith,et al. Door-to-needle times in acute ischemic stroke , 2012, Neurology.

[6] Adrian F Hernandez,et al. Timeliness of Tissue-Type Plasminogen Activator Therapy in Acute Ischemic Stroke: Patient Characteristics, Hospital Factors, and Outcomes Associated With Door-to-Needle Times Within 60 Minutes , 2011, Circulation.