Trends in Door-to-Thrombolysis Time in the Safe Implementation of Stroke Thrombolysis Registry: Effect of Center Volume and Duration of Registry Membership

Background and Purpose— Shorter delays between symptom onset and treatment translate into better outcomes after ischemic stroke thrombolysis. There are considerable intercenter variations in treatment delivery. We analyzed the trends of door-to-needle times (DNTs) in the Safe Implementation of Thrombolysis in Stroke registry between 2003 and 2011. Methods— We extracted from the Safe Implementation of Thrombolysis in Stroke registry (n=45 079) year of treatment, center code, DNT, sex, age, National Institutes of Health Stroke Scale, and comorbidity. For each center, the year they joined the registry and the annual volume of patients were determined (<5, 5–24, 25–49, 50–74, 75–99, and ≥100 patients/y). Results— DNT was not available for 720 (1.6%) patients. The overall mean (SD) DNT was 73 (37) minutes with a median (interquartile range) of 67 (47–91) minutes. The DNT was 65 (46–90), 68 (50–92), and 72 (51–98) minutes for centers joined early (2003–2005), later (2006–2009), and recently (2009–2011), respectively. Center volume had more robust effect on DNT than year of treatment, and the shortest DNTs were seen in centers with volumes ≥100 patients/y. Earlier enrollment period was also associated with shorter delays. Conclusions— Centers that joined the registry earlier and those with high annual volume achieved shorter DNT than centers that joined later and low-volume centers. However, in most of the centers, DNT did not change much during the registry period. A multicenter project aiming to reduce DNT is warranted.

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

[2]  C. Wolfe,et al.  Bigger, Faster?: Associations Between Hospital Thrombolysis Volume and Speed of Thrombolysis Administration in Acute Ischemic Stroke , 2013, Stroke.

[3]  Relationship Between Onset-to-Door Time and Door-to-Thrombolysis Time: A Pooled Analysis of 10 Dedicated Stroke Centers , 2013, Stroke.

[4]  D. Leys,et al.  Ultra-Early Intravenous Stroke Thrombolysis: Do All Patients Benefit Similarly? , 2013, Stroke.

[5]  Atte Meretoja,et al.  Helsinki model cut stroke thrombolysis delays to 25 minutes in Melbourne in only 4 months , 2013, Neurology.

[6]  Jin-Moo Lee,et al.  Reducing Door-to-Needle Times Using Toyota’s Lean Manufacturing Principles and Value Stream Analysis , 2012, Stroke.

[7]  Martin Pitt,et al.  Will Delays in Treatment Jeopardize the Population Benefit From Extending the Time Window for Stroke Thrombolysis? , 2012, Stroke.

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

[9]  Gary A. Ford,et al.  Predicting the Risk of Symptomatic Intracerebral Hemorrhage in Ischemic Stroke Treated With Intravenous Alteplase: Safe Implementation of Treatments in Stroke (SITS) Symptomatic Intracerebral Hemorrhage Risk Score , 2012, Stroke.

[10]  V. Demarin,et al.  Factors Influencing In-Hospital Delay in Treatment With Intravenous Thrombolysis , 2012, Stroke.

[11]  Eric E. Smith,et al.  Use of Tissue-Type Plasminogen Activator Before and After Publication of the European Cooperative Acute Stroke Study III in Get With The Guidelines-Stroke , 2012, Circulation. Cardiovascular quality and outcomes.

[12]  Eric E. Smith,et al.  Improving Door-to-Needle Times in Acute Ischemic Stroke: The Design and Rationale for the American Heart Association/American Stroke Association's Target Stroke Initiative , 2011, Stroke.

[13]  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.

[14]  Mark Parsons,et al.  Implementation and outcome of thrombolysis with alteplase 3–4·5 h after an acute stroke: an updated analysis from SITS-ISTR , 2010, The Lancet Neurology.

[15]  Gregory W Albers,et al.  Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials , 2010, The Lancet.

[16]  M. Kaste,et al.  Ultraearly Thrombolysis in Acute Ischemic Stroke Is Associated With Better Outcome and Lower Mortality , 2010, Stroke.

[17]  J. Broderick,et al.  Good clinical outcome after ischemic stroke with successful revascularization is time-dependent , 2009, Neurology.

[18]  Keith Muir,et al.  Thrombolysis with alteplase 3–4·5 h after acute ischaemic stroke (SITS-ISTR): an observational study , 2008, The Lancet.

[19]  M. Kaste,et al.  Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. , 2008, The New England journal of medicine.

[20]  J. M. Gordon.  HOSPITAL VOLUME AND STROKE OUTCOME: DOES IT MATTER? , 2007, Neurology.

[21]  A. Rabinstein,et al.  Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study , 2008 .

[22]  R. Sacco,et al.  Factors associated with in-hospital mortality after administration of thrombolysis in acute ischemic stroke patients: an analysis of the nationwide inpatient sample 1999 to 2002. , 2006, Stroke.

[23]  J. Saver.  Time Is Brain—Quantified , 2006, Stroke.

[24]  Scott Hamilton,et al.  Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials , 2004, The Lancet.

[25]  H. Ellis.  stroke , 1997, The Lancet.

[26]  S. Mayer,et al.  Relationship between the volume of craniotomies for cerebral aneurysm performed at New York state hospitals and in-hospital mortality. , 1996, Stroke.

[27]  A. Flood,et al.  Does Practice Make Perfect?: Part I: The Relation Between Hospital Volume and Outcomes for Selected Diagnostic Categories , 1984, Medical care.