title: Door to Intravenous Tissue Plasminogen Activator Time and Hospital Length of Stay in Acute Ischemic Stroke Patients, Georgia, 2007-2013.
abstract: BACKGROUND
  Ischemic stroke patients benefit most from intravenous thrombolysis when they receive the treatment as quickly as possible after symptom onset. Hospitals participating in the Georgia Coverdell Acute Stroke Registry reduced the time from patient arrival to administration of intravenous tissue plasminogen activator. This study evaluates the benefit of reducing door-to-treatment (DTT) time as measured by hospital length of stay (LOS).
  
  
  METHODS
  Data from 3154 ischemic stroke patients treated with intravenous thrombolysis from 2007 to 2013 were analyzed. The impact of door-to-treatment time on patients' length of hospital stay, discharge disposition, ambulatory status at discharge, and bleeding complications was assessed, controlling for patient-, hospital- and event-related characteristics.
  
  
  RESULTS
  Patients who received intravenous thrombolysis within 30 minutes of hospital arrival had a 19% shorter (95% confidence interval [CI]: 2%-32%, P value = .04) hospital LOS than those treated for more than 120 minutes after arrival. Patients treated within 60 minutes of arrival were 27% more likely (odds ratio = 1.28, 95% CI: 1.06-1.56, P = .01) to have a better discharge disposition than patients treated after 60 minutes of arrival while having a similar rate of bleeding complications.
  
  
  CONCLUSIONS
  Shortening the door-to-treatment time is associated with a decrease in patient LOS and better patient outcomes. Hospitals should be encouraged to measure, monitor, and reduce DTT time progressively for a better patient outcome.
authors: Division of Epidemiology & Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia; Georgia Department of Public Health, Atlanta, Georgia. Electronic address: Moges.Ido@dph.gov.ga.
authors: Moges Seyoum
authors: MS
authors: Ido
authors: Division of Epidemiology & Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia.
authors: Ike S
authors: IS
authors: Okosun
authors: Georgia Department of Public Health, Atlanta, Georgia.
authors: Rana
authors: R
authors: Bayakly
authors: Georgia Department of Public Health, Atlanta, Georgia.
authors: Lydia
authors: L
authors: Clarkson
authors: Georgia Department of Public Health, Atlanta, Georgia.
authors: James
authors: J
authors: Lugtu
authors: Georgia Department of Public Health, Atlanta, Georgia.
authors: Sanita
authors: S
authors: Floyd
authors: Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, School of Medicine, Emory University, Atlanta, Georgia.
authors: Kerrie
authors: K
authors: Krompf
authors: Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, School of Medicine, Emory University, Atlanta, Georgia.
authors: Michael
authors: M
authors: Frankel
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology* / Q000209:etiology; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Ischemic stroke; door-to-treatment time; hospital length of stay; intravenous thrombolysis; patient outcome; tissue plasminogen activator