title: Relationship between onset-to-door time and door-to-thrombolysis time: a pooled analysis of 10 dedicated stroke centers.
abstract: OBJECTIVE
  Inverse relationship between onset-to-door time (ODT) and door-to-needle time (DNT) in stroke thrombolysis was reported from various registries. We analyzed this relationship and other determinants of DNT in dedicated stroke centers.
  
  
  METHODS
  Prospectively collected data of consecutive ischemic stroke patients from 10 centers who received IV thrombolysis within 4.5 hours from symptom onset were merged (n=7106). DNT was analyzed as a function of demographic and prehospital variables using regression analyses, and change over time was considered.
  
  
  RESULTS
  In 6348 eligible patients with known treatment delays, median DNT was 42 minutes and kept decreasing steeply every year (P<0.001). Median DNT of 55 minutes was observed in patients with ODT ≤30 minutes, whereas it declined for patients presenting within the last 30 minutes of the 3-hour time window (median, 33 minutes) and of the 4.5-hour time window (20 minutes). For ODT within the first 30 minutes of the extended time window (181-210 minutes), DNT increased to 42 minutes. DNT was stable for ODT for 30 to 150 minutes (40-45 minutes). We found a weak inverse overall correlation between ODT and DNT (R(2)=-0.12; P<0.001), but it was strong in patients treated between 3 and 4.5 hours (R(2)=-0.75; P<0.001). ODT was independently inversely associated with DNT (P<0.001) in regression analysis. Octogenarians and women tended to have longer DNT.
  
  
  CONCLUSIONS
  DNT was decreasing steeply over the last years in dedicated stroke centers; however, significant oscillations of in-hospital treatment delays occurred at both ends of the time window. This suggests that further improvements can be achieved, particularly in the elderly.
authors.affiliation: From the Department of Neurology and Stroke Unit, Helsinki University Central Hospital, Helsinki, Finland (D.S., M.T., T.T.); Department of Neurology and Stroke Unit, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland (P.M., A.E.); Department of Neurology and Stroke Unit, University of Heidelberg, Heidelberg, Germany (P.R., C.G., W.H.); Department of Neurology and Stroke Unit, Tampere University Hospital, Tampere, Finland (H.N., A.-K.P.); Department of Neurology and Stroke Unit, Universitätsklinikum Erlangen, Erlangen, Germany (L.B., M.K.); Department of Neurology and Stroke Unit, University Lille Nord de France (M.B., D.L.); Department of Neurology and Stroke Unit, University Hospital Basel, Basel, Switzerland (D.J.S., H.G., S.T.E.); Department of Neurology and Stroke Unit, University of Bern, Bern, Switzerland (S.J., B.W., H.P.M.); Department of Neurology and Stroke Unit, Hospital Clínic Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain (V.O., A.C.); and Department of Neurology and Stroke Unit, Kantonsspital St. Gallen, St. Gallen, Switzerland (B.W.).
authors.forename: Daniel
authors.initials: D
authors.lastname: Strbian
authors.forename: Patrik
authors.initials: P
authors.lastname: Michel
authors.forename: Peter
authors.initials: P
authors.lastname: Ringleb
authors.forename: Heikki
authors.initials: H
authors.lastname: Numminen
authors.forename: Lorenz
authors.initials: L
authors.lastname: Breuer
authors.forename: Marie
authors.initials: M
authors.lastname: Bodenant
authors.forename: David J
authors.initials: DJ
authors.lastname: Seiffge
authors.forename: Simon
authors.initials: S
authors.lastname: Jung
authors.forename: Victor
authors.initials: V
authors.lastname: Obach
authors.forename: Bruno
authors.initials: B
authors.lastname: Weder
authors.forename: Marjaana
authors.initials: M
authors.lastname: Tiainen
authors.forename: Ashraf
authors.initials: A
authors.lastname: Eskandari
authors.forename: Christoph
authors.initials: C
authors.lastname: Gumbinger
authors.forename: Henrik
authors.initials: H
authors.lastname: Gensicke
authors.forename: Angel
authors.initials: A
authors.lastname: Chamorro
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.forename: Stefan T
authors.initials: ST
authors.lastname: Engelter
authors.forename: Didier
authors.initials: D
authors.lastname: Leys
authors.forename: Martin
authors.initials: M
authors.lastname: Köhrmann
authors.forename: Anna-Kaisa
authors.initials: AK
authors.lastname: Parkkila
authors.forename: Werner
authors.initials: W
authors.lastname: Hacke
authors.forename: Turgut
authors.initials: T
authors.lastname: Tatlisumak
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000592:standards*; D005060:Europe; D005260:Female; D006760:Hospitalization; D006782:Hospitals, Special; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D020521:Stroke / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods / Q000592:standards; D013997:Time Factors
keywords: door-to-needle time; emergencies; ischemic stroke; outcome; thrombolysis