title: Factors associated with in-hospital delays in treating acute stroke with intravenous thrombolysis in a tertiary centre.
abstract: OBJECTIVE
  This study aims to determine which factors are associated with delays in door-to needle (DTN) time in our hospital. This will help us design future strategies to shorten time to treatment with intravenous thrombolysis (IVT).
  
  
  METHODS
  Retrospective analysis of a prospective cohort of patients with ischaemic stroke treated with IVT in our hospital between 2009 and 2012. We analysed the relationship between DTN time and the following variables: age, sex, personal medical history, onset-to-door time, pre-hospital stroke code activation, blood pressure and blood glucose level, National Institutes of Health Stroke Scale (NIHSS), computed tomography angiography (CTA) and/or doppler/duplex ultrasound (DUS) performed before IVT, time to hospital arrival, and day of the week and year of stroke.
  
  
  RESULTS
  Our hospital treated 239 patients. Median time to treatment in minutes (IQR): onset-to-door, 84 (60-120); door-to-CT, 17 (13-24.75); CT-to needle, 34 (26-47); door-to-needle, 52 (43-70); onset-to-needle, 145 (120-180). Door-to-needle time was significantly shorter when code stroke was activated, at 51 vs. 72min (P=0.008), and longer when CTA was performed, at 59 vs. 48.5min (P=0.004); it was also longer with an onset-to-door time<90min, at 58 vs. 48min (P=0.003). The multivariate linear regression analysis detected 2 factors affecting DTN: code stroke activation (26.3% reduction; P<0.001) and onset-to-door time (every 30min of onset-to-door delay corresponded to a 4.7min increase in DTN time [P=0.02]). On the other hand, CTA resulted in a 13.4% increase in DTN (P=0.03). No other factors had a significant influence on door-to-needle time.
  
  
  CONCLUSIONS
  This study enabled us to identify CTA and the «3-hour effect» as the 2 factors that delay IVT in our hospital. In contrast, activating code stroke clearly reduces DTN. This information will be useful in our future attempts to reduce door-to-needle times.
authors: Unidad de Ictus, Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España. Electronic address: Angarpas@yahoo.es.
authors: A M
authors: AM
authors: Iglesias Mohedano
authors: Unidad de Ictus, Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: A
authors: A
authors: García Pastor
authors: Unidad de Ictus, Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: A
authors: A
authors: García Arratibel
authors: Unidad de Ictus, Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: P
authors: P
authors: Sobrino García
authors: Unidad de Ictus, Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: F
authors: F
authors: Díaz Otero
authors: Unidad de Ictus, Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: F
authors: F
authors: Romero Delgado
authors: Unidad de Ictus, Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: R
authors: R
authors: Domínguez Rubio
authors: Unidad de Ictus, Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: A
authors: A
authors: Muñoz González
authors: Unidad de Ictus, Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: P
authors: P
authors: Vázquez Alen
authors: Unidad de Ictus, Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: Y
authors: Y
authors: Fernández Bullido
authors: Unidad de Ictus, Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: J A
authors: JA
authors: Villanueva Osorio
authors: Unidad de Ictus, Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors: A
authors: A
authors: Gil Núñez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013030:Spain; D020521:Stroke / Q000000981:diagnostic imaging / Q000628:therapy*; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: Angio-TC; Computed tomography angiography; Door-to-needle time; Efecto de las 3horas; Ictus isquémico; In-hospital delays; Intravenous thrombolysis; Ischaemic stroke; Retraso intrahospitalario; Three-hour effect; Tiempo puerta-aguja; Trombólisis intravenosa