title: Do efforts to decrease door-to-needle time risk increasing stroke mimic treatment rates?
abstract: An unintended consequence of rapid thrombolysis may be more frequent treatment of stroke mimics, nonvascular conditions that simulate stroke. We explored the relationship between door-to-needle (DTN) times and thrombolysis of stroke mimics at a single academic center by analyzing consecutive quartiles of patients who were treated with IV tissue plasminogen activator for suspected stroke from January 1, 2010 to February 28, 2014. An increase in the proportion of stroke mimic patients (6.7% in each of the 1st and 2nd, 12.9% in the 3rd, and 30% in the last consecutive case quartile;p= 0.03) and a decrease in median DTN time from 89 to 56 minutes (p< 0.01) was found. As more centers reduce DTN times, the rates of stroke mimic treatment should be carefully monitored.
authors.affiliation: Department of Neurology (ALL, EML, FZC, IR, MBM, RAB, DB, SP) and Department of Emergency Medicine (RK), Northwestern University-Feinberg School of Medicine, Chicago, IL.
authors.forename: Ava L
authors.initials: AL
authors.lastname: Liberman
authors.affiliation: Department of Neurology (ALL, EML, FZC, IR, MBM, RAB, DB, SP) and Department of Emergency Medicine (RK), Northwestern University-Feinberg School of Medicine, Chicago, IL.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Liotta
authors.affiliation: Department of Neurology (ALL, EML, FZC, IR, MBM, RAB, DB, SP) and Department of Emergency Medicine (RK), Northwestern University-Feinberg School of Medicine, Chicago, IL.
authors.forename: Fan Z
authors.initials: FZ
authors.lastname: Caprio
authors.affiliation: Department of Neurology (ALL, EML, FZC, IR, MBM, RAB, DB, SP) and Department of Emergency Medicine (RK), Northwestern University-Feinberg School of Medicine, Chicago, IL.
authors.forename: Ilana
authors.initials: I
authors.lastname: Ruff
authors.affiliation: Department of Neurology (ALL, EML, FZC, IR, MBM, RAB, DB, SP) and Department of Emergency Medicine (RK), Northwestern University-Feinberg School of Medicine, Chicago, IL.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Maas
authors.affiliation: Department of Neurology (ALL, EML, FZC, IR, MBM, RAB, DB, SP) and Department of Emergency Medicine (RK), Northwestern University-Feinberg School of Medicine, Chicago, IL.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Bernstein
authors.affiliation: Department of Neurology (ALL, EML, FZC, IR, MBM, RAB, DB, SP) and Department of Emergency Medicine (RK), Northwestern University-Feinberg School of Medicine, Chicago, IL.
authors.forename: Rahul
authors.initials: R
authors.lastname: Khare
authors.affiliation: Department of Neurology (ALL, EML, FZC, IR, MBM, RAB, DB, SP) and Department of Emergency Medicine (RK), Northwestern University-Feinberg School of Medicine, Chicago, IL.
authors.forename: Deborah
authors.initials: D
authors.lastname: Bergman
authors.affiliation: Department of Neurology (ALL, EML, FZC, IR, MBM, RAB, DB, SP) and Department of Emergency Medicine (RK), Northwestern University-Feinberg School of Medicine, Chicago, IL.
authors.forename: Shyam
authors.initials: S
authors.lastname: Prabhakaran