title: Trends in Door-to-Thrombolysis Time in the Safe Implementation of Stroke Thrombolysis Registry: Effect of Center Volume and Duration of Registry Membership.
abstract: OBJECTIVE
  Shorter delays between symptom onset and treatment translate into better outcomes after ischemic stroke thrombolysis. There are considerable intercenter variations in treatment delivery. We analyzed the trends of door-to-needle times (DNTs) in the Safe Implementation of Thrombolysis in Stroke registry between 2003 and 2011.
  
  
  METHODS
  We extracted from the Safe Implementation of Thrombolysis in Stroke registry (n=45 079) year of treatment, center code, DNT, sex, age, National Institutes of Health Stroke Scale, and comorbidity. For each center, the year they joined the registry and the annual volume of patients were determined (<5, 5-24, 25-49, 50-74, 75-99, and ≥100 patients/y).
  
  
  RESULTS
  DNT was not available for 720 (1.6%) patients. The overall mean (SD) DNT was 73 (37) minutes with a median (interquartile range) of 67 (47-91) minutes. The DNT was 65 (46-90), 68 (50-92), and 72 (51-98) minutes for centers joined early (2003-2005), later (2006-2009), and recently (2009-2011), respectively. Center volume had more robust effect on DNT than year of treatment, and the shortest DNTs were seen in centers with volumes ≥100 patients/y. Earlier enrollment period was also associated with shorter delays.
  
  
  CONCLUSIONS
  Centers that joined the registry earlier and those with high annual volume achieved shorter DNT than centers that joined later and low-volume centers. However, in most of the centers, DNT did not change much during the registry period. A multicenter project aiming to reduce DNT is warranted.
authors.affiliation: From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (D.S., T.T.); Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (N.A., N.W.); Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, United Kingdom (K.R.L.); Emergency Department Stroke Unit, Department of Neurology and Psychiatry, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Rome, Italy (D.T.); University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom (C.R.); and Institute for Molecular Medicine Finland, University of Helsinki, Finland (I.L.S.). daniel.strbian@hus.fi.
authors.forename: Daniel
authors.initials: D
authors.lastname: Strbian
authors.affiliation: From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (D.S., T.T.); Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (N.A., N.W.); Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, United Kingdom (K.R.L.); Emergency Department Stroke Unit, Department of Neurology and Psychiatry, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Rome, Italy (D.T.); University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom (C.R.); and Institute for Molecular Medicine Finland, University of Helsinki, Finland (I.L.S.).
authors.forename: Niaz
authors.initials: N
authors.lastname: Ahmed
authors.affiliation: From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (D.S., T.T.); Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (N.A., N.W.); Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, United Kingdom (K.R.L.); Emergency Department Stroke Unit, Department of Neurology and Psychiatry, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Rome, Italy (D.T.); University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom (C.R.); and Institute for Molecular Medicine Finland, University of Helsinki, Finland (I.L.S.).
authors.forename: Nils
authors.initials: N
authors.lastname: Wahlgren
authors.affiliation: From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (D.S., T.T.); Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (N.A., N.W.); Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, United Kingdom (K.R.L.); Emergency Department Stroke Unit, Department of Neurology and Psychiatry, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Rome, Italy (D.T.); University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom (C.R.); and Institute for Molecular Medicine Finland, University of Helsinki, Finland (I.L.S.).
authors.forename: Kennedy R
authors.initials: KR
authors.lastname: Lees
authors.affiliation: From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (D.S., T.T.); Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (N.A., N.W.); Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, United Kingdom (K.R.L.); Emergency Department Stroke Unit, Department of Neurology and Psychiatry, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Rome, Italy (D.T.); University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom (C.R.); and Institute for Molecular Medicine Finland, University of Helsinki, Finland (I.L.S.).
authors.forename: Danilo
authors.initials: D
authors.lastname: Toni
authors.affiliation: From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (D.S., T.T.); Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (N.A., N.W.); Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, United Kingdom (K.R.L.); Emergency Department Stroke Unit, Department of Neurology and Psychiatry, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Rome, Italy (D.T.); University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom (C.R.); and Institute for Molecular Medicine Finland, University of Helsinki, Finland (I.L.S.).
authors.forename: Christine
authors.initials: C
authors.lastname: Roffe
authors.affiliation: From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (D.S., T.T.); Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (N.A., N.W.); Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, United Kingdom (K.R.L.); Emergency Department Stroke Unit, Department of Neurology and Psychiatry, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Rome, Italy (D.T.); University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom (C.R.); and Institute for Molecular Medicine Finland, University of Helsinki, Finland (I.L.S.).
authors.forename: Ida L
authors.initials: IL
authors.lastname: Surakka
authors.affiliation: From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (D.S., T.T.); Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (N.A., N.W.); Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, United Kingdom (K.R.L.); Emergency Department Stroke Unit, Department of Neurology and Psychiatry, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Rome, Italy (D.T.); University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom (C.R.); and Institute for Molecular Medicine Finland, University of Helsinki, Finland (I.L.S.).
authors.forename: Turgut
authors.initials: T
authors.lastname: Tatlisumak
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012042:Registries; D020521:Stroke / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data / Q000639:trends*; D061665:Time-to-Treatment / Q000639:trends*; D016896:Treatment Outcome; D014481:United States
keywords: stroke; thrombolysis; thrombolytic therapy; time-to-treatment