Abstract W MP81: A Door-to-Needle Time Under 30 Minutes Can Be Achieved and Can Improve Functional Outcomes
Background: Improvements in functional outcomes are greatest when intravenous tissue plasminogen activator (IV-tPA) is administered immediately following acute ischemic stroke (AIS). Our study objectives were to describe interventions administered by our Comprehensive Stroke Center to improve door-to-needle (DTN) time, report median DTN times, and determine if interventions influenced functional outcomes and sICH rates.
Methods: A DTN task force was created to streamline care of suspected AIS patients; interventions included developing a launch pad for emergent evaluation near registration staffed by a neurologist, physician and stroke program coordinator, transferring patients directly to CT room before entering an ED room, and giving IV-tPA in the CT room. We examined patients that received IV-tPA between 1/1/10 - 6/25/14 and compared median DTN times and discharge mRS over the study period using the Kruskal-Wallis analysis of variance. The chi-square trend test was used to compare proportions of patients receiving IV-tPA in less than 60 minutes.
Results: During the study period 245 patients received IV-tPA. There was a significant decrease in median DTN times over time, from 46 minutes in 2010 to 29 minutes in 2014 (p=.001, Graph), and there was a significant trend towards shorter DTN times over time (p<.001, Graph). Additionally, discharge mRS significantly improved over time (p=.03). There was 1 case of sICH in 2010 and 2012.
Conclusions: Streamlining initial evaluation of suspected AIS patients can reduce DTN times, and was also associated with improvements in functional outcomes at discharge. There was no change in sICH rates.
Author Disclosures: M. Whaley: None. L.M. Caputo: None. M.J. Kozlowski: None. C.V. Fanale: None. J.C. Wagner: None. D. Bar-Or: None.
- © 2015 by American Heart Association, Inc.