title: Factors influencing door-to-imaging time: analysis of the safe implementation of treatments in Stroke-EAST registry.
abstract: BACKGROUND
  Brain imaging is logistically the most difficult step before thrombolysis. To improve door-to-needle time (DNT), it is important to understand if (1) longer door-to-imaging time (DIT) results in longer DNT, (2) hospitals have different DIT performances, and (3) patient and hospital characteristics predict DIT.
  
  
  METHODS
  Prospectively collected data in the Safe Implementation of Treatments in Stroke-EAST (SITS-EAST) registry from Central/Eastern European countries between 2008 and 2011 were analyzed. Hospital characteristics were obtained by questionnaire from each center. Patient- and hospital-level predictors of DIT of 25 minutes or less were identified by the method of generalized estimating equations.
  
  
  RESULTS
  Altogether 6 of 9 SITS-EAST countries participated with 4212 patients entered into the database of which 3631 (86%) had all required variables. DIT of 25 minutes or less was achieved in 2464 (68%) patients (range, 3%-93%; median, 65%; and interquartile range, 50%-80% between centers). Patients with DIT of 25 minutes or less had shorter DNT (median, 60 minutes) than patients with DIT of more than 25 minutes (median, 86 minutes; P < .001). Four variables independently predicted DIT of 25 minutes or less: longer time from stroke onset to admission (91-180 versus 0-90 minutes; odds ratio [OR], 1.6; 95% confidence interval [CI], 1.3-1.8), transport time of 5 minutes or less (OR, 2.9; 95% CI, 1.7-4.7) between the place of admission and a computed tomography (CT) scanner, no or minimal neurologic deficit before stroke (OR, 1.3; 95% CI, 1.02-1.5), and diabetes mellitus (OR, .8; 95% CI, .7-.97).
  
  
  CONCLUSIONS
  DIT should be improved in patients arriving early and late. Place of admission should allow transport time to a CT scanner under 5 minutes.
authors.affiliation: International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic; Department of Neurology, St. Anne's University Hospital and Medical Faculty of Masaryk University, Brno, Czech Republic.
authors.forename: Michal
authors.initials: M
authors.lastname: Haršány
authors.affiliation: International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic.
authors.forename: Pavla
authors.initials: P
authors.lastname: Kadlecová
authors.affiliation: Department of Vascular Neurology and Neurological Intensive Care, University Medical Centre Ljubljana and Zdravstveni Nasveti, Ljubljana, Slovenia.
authors.forename: Viktor
authors.initials: V
authors.lastname: Švigelj
authors.affiliation: Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia.
authors.forename: Janika
authors.initials: J
authors.lastname: Kõrv
authors.affiliation: Department of Neurology, Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia.
authors.forename: Vanja Bašić
authors.initials: VB
authors.lastname: Kes
authors.affiliation: Department of Neurology and Neurosurgery, Vilnus University and Republican Vilnius University Hospital, Vilnius, Lithuania.
authors.forename: Aleksandras
authors.initials: A
authors.lastname: Vilionskis
authors.affiliation: Stroke Rehabilitation and Research Unit, Memorial Healthcare Group Stroke Center, Memorial Şişli Hospital, Istanbul, Turkey.
authors.forename: Yakup
authors.initials: Y
authors.lastname: Krespi
authors.affiliation: International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic; Department of Neurology, St. Anne's University Hospital and Medical Faculty of Masaryk University, Brno, Czech Republic. Electronic address: mikulik@hotmail.com.
authors.forename: Robert
authors.initials: R
authors.lastname: Mikulík
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D003952:Diagnostic Imaging / Q000592:standards*; D042241:Early Diagnosis; D005260:Female; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D020521:Stroke / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D011795:Surveys and Questionnaires; D013997:Time Factors; D014057:Tomography, X-Ray Computed
keywords: Door-to-imaging time; acute stroke; door-to-needle time; imaging; ischemic stroke; thrombolysis