title: Factors influencing in-hospital delay in treatment with intravenous thrombolysis.
abstract: OBJECTIVE
  Shortening door-to-needle time (DNT) for the thrombolytic treatment of stroke can improve treatment efficacy by reducing onset-to-treatment time. The goal of our study was to explore the association between DNT and outcome and to identify factors influencing DNT to better understand why some patients are treated late.
  
  
  METHODS
  Prospectively collected data from the Safe Implementation of Treatments in Stroke-East registry (SITS-EAST: 9 central and eastern European countries) on all patients treated with thrombolysis between February 2003 and February 2010 were analyzed. Multiple logistic regression analysis was used to identify predictors of DNT ≤ 60 minutes.
  
  
  RESULTS
  Altogether, 5563 patients were treated with thrombolysis within 4.5 hours of symptom onset. Of these, 2097 (38%) had DNT ≤ 60 minutes. In different centers, the proportion of patients treated with DNT ≤ 60 minutes ranged from 18% to 84% (P<0.0001). Patients with longer DNT (in 60-minute increments) had less chance of achieving a modified Rankin Scale score of 0 to 1 at 3 months (adjusted OR, 0.86; 95% CI, 0.77-0.97). DNT ≤ 60 minutes was independently predicted by younger age (in 10-year increments; OR, 0.92; 95% CI, 0.87-0.97), National Institutes of Health Stroke Scale score 7 to 24 (OR, 1.44; 95% CI, 1.2-1.7), onset-to-door time (in 10-minute increments; OR, 1.19; 95% CI, 1.17-1.22), treatment center (P<0.001), and country (P<0.001).
  
  
  CONCLUSIONS
  Thrombolysis of patients with older age and mild or severe neurological deficit is delayed. The perception that there is sufficient time before the end of the thrombolytic window also delays treatment. It is necessary to improve adherence to guidelines and to treat patients sooner after arrival to hospital.
authors.affiliation: Neurology Department, St Annes Hospital in Brno, Pekarska 53, Brno, Czech Republic 65691. mikulik@hotmail.com
authors.forename: Robert
authors.initials: R
authors.lastname: Mikulík
authors.forename: Pavla
authors.initials: P
authors.lastname: Kadlecová
authors.forename: Anna
authors.initials: A
authors.lastname: Czlonkowska
authors.forename: Adam
authors.initials: A
authors.lastname: Kobayashi
authors.forename: Miroslav
authors.initials: M
authors.lastname: Brozman
authors.forename: Viktor
authors.initials: V
authors.lastname: Svigelj
authors.forename: Laszlo
authors.initials: L
authors.lastname: Csiba
authors.forename: Klara
authors.initials: K
authors.lastname: Fekete
authors.forename: Janika
authors.initials: J
authors.lastname: Kõrv
authors.forename: Vida
authors.initials: V
authors.lastname: Demarin
authors.forename: Aleksandras
authors.initials: A
authors.lastname: Vilionskis
authors.forename: Dalius
authors.initials: D
authors.lastname: Jatuzis
authors.forename: Yakup
authors.initials: Y
authors.lastname: Krespi
authors.forename: Niaz
authors.initials: N
authors.lastname: Ahmed
mesh_terms: D000367:Age Factors; D000368:Aged; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000150:complications / Q000628:therapy; D011446:Prospective Studies; D020521:Stroke / Q000150:complications / Q000628:therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors