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In-Hospital Delays in Stroke Thrombolysis : Every Minute Counts

Darehed, David ; Blom, Mathias LU ; Glader, Eva Lotta ; Niklasson, Johan ; Norrving, Bo LU and Eriksson, Marie (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.

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author
; ; ; ; and
organization
publishing date
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
2024-05-15 15:50:03
@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 &lt;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}},
}