Association between i.v. thrombolysis volume and door-to-needle times in acute ischemic stroke

Centralization of intravenous thrombolysis (IVT) for acute ischemic stroke in high-volume centers is believed to improve the door-to-needle times (DNT), but limited data support this assumption. We examined the association between DNT and IVT volume in a large Dutch province. We identified consecuti...

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Bibliographic Details
Published in:	Journal of neurology Vol. 263; no. 4; pp. 807 - 813
Main Authors:	Groot, Adrien E., van Schaik, Ivo N., Visser, Marieke C., Nederkoorn, Paul J., Limburg, Martien, Aramideh, Majid, de Beer, Frank, Zwetsloot, Caspar P., Halkes, Patricia, de Kruijk, Jelle, Kruyt, Nyika D., van der Meulen, Willem, Spaander, Fianne, van der Ree, Taco, Kwa, Vincent I. H., Van den Berg-Vos, Renske M., Roos, Yvo B., Coutinho, Jonathan M.
Format:	Journal Article
Language:	English
Published:	Berlin/Heidelberg Springer Berlin Heidelberg 01-04-2016 Springer Nature B.V
Subjects:	Aged Cohort Studies Female Fibrinolytic Agents - administration & dosage Humans Infusions, Intravenous Ischemia Male Medicine Medicine & Public Health Middle Aged Netherlands Neurology Neuroradiology Neurosciences Original Communication Stroke Stroke - drug therapy Thrombolytic Therapy - methods Time Factors Time-to-Treatment United States > US Netherlands Stroke High-volume Door-to-needle time Hospitals Thrombolytic therapy
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Summary:	Centralization of intravenous thrombolysis (IVT) for acute ischemic stroke in high-volume centers is believed to improve the door-to-needle times (DNT), but limited data support this assumption. We examined the association between DNT and IVT volume in a large Dutch province. We identified consecutive patients treated with IVT between January 2009 and 2013. Based on annualized IVT volume, hospitals were categorized as low-volume (≤24), medium-volume (25–49) or high-volume (≥50). In logistic regression analysis, low-volume hospitals were used as reference category. Of 17,332 stroke patients from 11 participating hospitals, 1962 received IVT (11.3 %). We excluded 140 patients because of unknown DNT ( n = 86) or in-hospital stroke ( n = 54). There were two low-volume (total 101 patients), five medium-volume (747 patients) and four high-volume hospitals (974 patients). Median DNT was shorter in high-volume hospitals (30 min) than in medium-volume (42 min, p < 0.001) and low-volume hospitals (38 min, p < 0.001). Patients admitted to high-volume hospitals had a higher chance of DNT < 30 min (adjusted OR 3.13, 95 % CI 1.70–5.75), lower risk of symptomatic intracerebral hemorrhage (adjusted OR 0.39, 95 % CI 0.16–0.92), and a lower mortality risk (adjusted OR 0.45, 95 % CI 0.21–1.01), compared to low-volume centers. There was no difference in DNT between low- and medium-volume hospitals. Onset-to-needle times (ONT) did not differ between the groups. Hospitals in this Dutch province generally achieved short DNTs. Despite this overall good performance, higher IVT volumes were associated with shorter DNTs and lower complication risks. The ONT was not associated with IVT volume.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0340-5354 1432-1459
DOI:	10.1007/s00415-016-8076-5