In-Hospital Delays in Stroke Thrombolysis : Every Minute Counts
(2020) In Stroke 51(8). p.2536-2539- Abstract
BACKGROUND AND PURPOSE: Intravenous thrombolysis is a well-established treatment for acute ischemic stroke. Our aim was to quantify the effect of each minute delay in door-to-needle time (DNT) on 90-day survival, intracerebral hemorrhagic complication <36 hours, and functional outcomes at 3 months, in routine clinical practice. METHODS: Our nationwide registry-based study included 14 132 adult patient admissions with ischemic stroke receiving intravenous thrombolysis from 2010 to 2017. Outcomes were analyzed using multivariable logistic regression, adjusting for potential confounders. RESULTS: Median DNT was 47 minutes, with an improvement from 65 to 38 minutes during the study. Median age was 74 years, and median National Institutes... (More)
BACKGROUND AND PURPOSE: Intravenous thrombolysis is a well-established treatment for acute ischemic stroke. Our aim was to quantify the effect of each minute delay in door-to-needle time (DNT) on 90-day survival, intracerebral hemorrhagic complication <36 hours, and functional outcomes at 3 months, in routine clinical practice. METHODS: Our nationwide registry-based study included 14 132 adult patient admissions with ischemic stroke receiving intravenous thrombolysis from 2010 to 2017. Outcomes were analyzed using multivariable logistic regression, adjusting for potential confounders. RESULTS: Median DNT was 47 minutes, with an improvement from 65 to 38 minutes during the study. Median age was 74 years, and median National Institutes of Health Stroke Scale 8 points. We found a significant impact of each minute delay in DNT with reduced odds of survival by 0.6%, increased odds of intracerebral hemorrhagic and worse activities of daily living by 0.3%, and worse living conditions and mobility by 0.4%. CONCLUSIONS: Improving DNT is a key factor in achieving good outcomes after stroke. We estimate that in Sweden alone in 2017, compared with 2010, the shorter DNT achieved have saved 38 lives, avoided 8 intracerebral hemorrhagic transformations, and spared, respectively, 36, 51, and 52 patients from a worsening in activities of daily living, living conditions, and mobility. DNT is sensitive for interventions and should be targeted in quality improvement efforts.
(Less)
- author
- Darehed, David ; Blom, Mathias LU ; Glader, Eva Lotta ; Niklasson, Johan ; Norrving, Bo LU and Eriksson, Marie
- organization
- publishing date
- 2020
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- activities of daily living, mortality, quality improvement, survival, thrombolysis
- in
- Stroke
- volume
- 51
- issue
- 8
- pages
- 4 pages
- publisher
- American Heart Association
- external identifiers
-
- scopus:85088847939
- pmid:32586222
- ISSN
- 1524-4628
- DOI
- 10.1161/STROKEAHA.120.029468
- language
- English
- LU publication?
- yes
- id
- 0225815b-bdf5-4647-ab9a-d5dbcc55c102
- date added to LUP
- 2020-08-07 12:56:04
- date last changed
- 2024-09-05 02:32:15
@article{0225815b-bdf5-4647-ab9a-d5dbcc55c102, abstract = {{<p>BACKGROUND AND PURPOSE: Intravenous thrombolysis is a well-established treatment for acute ischemic stroke. Our aim was to quantify the effect of each minute delay in door-to-needle time (DNT) on 90-day survival, intracerebral hemorrhagic complication <36 hours, and functional outcomes at 3 months, in routine clinical practice. METHODS: Our nationwide registry-based study included 14 132 adult patient admissions with ischemic stroke receiving intravenous thrombolysis from 2010 to 2017. Outcomes were analyzed using multivariable logistic regression, adjusting for potential confounders. RESULTS: Median DNT was 47 minutes, with an improvement from 65 to 38 minutes during the study. Median age was 74 years, and median National Institutes of Health Stroke Scale 8 points. We found a significant impact of each minute delay in DNT with reduced odds of survival by 0.6%, increased odds of intracerebral hemorrhagic and worse activities of daily living by 0.3%, and worse living conditions and mobility by 0.4%. CONCLUSIONS: Improving DNT is a key factor in achieving good outcomes after stroke. We estimate that in Sweden alone in 2017, compared with 2010, the shorter DNT achieved have saved 38 lives, avoided 8 intracerebral hemorrhagic transformations, and spared, respectively, 36, 51, and 52 patients from a worsening in activities of daily living, living conditions, and mobility. DNT is sensitive for interventions and should be targeted in quality improvement efforts.</p>}}, author = {{Darehed, David and Blom, Mathias and Glader, Eva Lotta and Niklasson, Johan and Norrving, Bo and Eriksson, Marie}}, issn = {{1524-4628}}, keywords = {{activities of daily living; mortality; quality improvement; survival; thrombolysis}}, language = {{eng}}, number = {{8}}, pages = {{2536--2539}}, publisher = {{American Heart Association}}, series = {{Stroke}}, title = {{In-Hospital Delays in Stroke Thrombolysis : Every Minute Counts}}, url = {{http://dx.doi.org/10.1161/STROKEAHA.120.029468}}, doi = {{10.1161/STROKEAHA.120.029468}}, volume = {{51}}, year = {{2020}}, }