title: Association between i.v. thrombolysis volume and door-to-needle times in acute ischemic stroke.
abstract: Centralization of intravenous thrombolysis (IVT) for acute ischemic stroke in high-volume centers is believed to improve the door-to-needle times (DNT), but limited data support this assumption. We examined the association between DNT and IVT volume in a large Dutch province. We identified consecutive patients treated with IVT between January 2009 and 2013. Based on annualized IVT volume, hospitals were categorized as low-volume (≤ 24), medium-volume (25-49) or high-volume (≥ 50). In logistic regression analysis, low-volume hospitals were used as reference category. Of 17,332 stroke patients from 11 participating hospitals, 1962 received IVT (11.3 %). We excluded 140 patients because of unknown DNT (n = 86) or in-hospital stroke (n = 54). There were two low-volume (total 101 patients), five medium-volume (747 patients) and four high-volume hospitals (974 patients). Median DNT was shorter in high-volume hospitals (30 min) than in medium-volume (42 min, p < 0.001) and low-volume hospitals (38 min, p < 0.001). Patients admitted to high-volume hospitals had a higher chance of DNT < 30 min (adjusted OR 3.13, 95 % CI 1.70-5.75), lower risk of symptomatic intracerebral hemorrhage (adjusted OR 0.39, 95 % CI 0.16-0.92), and a lower mortality risk (adjusted OR 0.45, 95 % CI 0.21-1.01), compared to low-volume centers. There was no difference in DNT between low- and medium-volume hospitals. Onset-to-needle times (ONT) did not differ between the groups. Hospitals in this Dutch province generally achieved short DNTs. Despite this overall good performance, higher IVT volumes were associated with shorter DNTs and lower complication risks. The ONT was not associated with IVT volume.
authors.affiliation: Department of Neurology, Academic Medical Center, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
authors.forename: Adrien E
authors.initials: AE
authors.lastname: Groot
authors.affiliation: Department of Neurology, Academic Medical Center, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
authors.forename: Ivo N
authors.initials: IN
authors.lastname: van Schaik
authors.affiliation: Department of Neurology, VU Medical Center, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands.
authors.forename: Marieke C
authors.initials: MC
authors.lastname: Visser
authors.affiliation: Department of Neurology, Academic Medical Center, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nederkoorn
authors.affiliation: Department of Neurology, Flevoziekenhuis, Hospitaalweg 1, 1315, RA, Almere, The Netherlands.
authors.forename: Martien
authors.initials: M
authors.lastname: Limburg
authors.affiliation: Department of Neurology, Medical Centre Alkmaar, Wilhelminalaan 12, 1815, JD, Alkmaar, The Netherlands.
authors.forename: Majid
authors.initials: M
authors.lastname: Aramideh
authors.affiliation: Department of Neurology, Kennemer Gasthuis, Boerhaavelaan 22, 2035, RC, Haarlem, The Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: de Beer
authors.affiliation: Department of Neurology, Waterland, Waterlandlaan 250, 1441, RN, Purmerend, The Netherlands.
authors.forename: Caspar P
authors.initials: CP
authors.lastname: Zwetsloot
authors.affiliation: Department of Neurology, Medical Centre Alkmaar, Wilhelminalaan 12, 1815, JD, Alkmaar, The Netherlands.
authors.forename: Patricia
authors.initials: P
authors.lastname: Halkes
authors.affiliation: Department of Neurology, Tergooi Ziekenhuis, Rijksstraat 1, 1261, AN, Blaricum, The Netherlands.
authors.forename: Jelle
authors.initials: J
authors.lastname: de Kruijk
authors.affiliation: Department of Neurology, Slotervaart, Louwesweg 6, 1066, EC, Amsterdam, The Netherlands.|Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands.
authors.forename: Nyika D
authors.initials: ND
authors.lastname: Kruyt
authors.affiliation: Department of Neurology, Rode Kruis Ziekenhuis, Vondellaan 13, 1942, LE, Beverwijk, The Netherlands.
authors.forename: Willem
authors.initials: W
authors.lastname: van der Meulen
authors.affiliation: Department of Neurology, Slotervaart, Louwesweg 6, 1066, EC, Amsterdam, The Netherlands.
authors.forename: Fianne
authors.initials: F
authors.lastname: Spaander
authors.affiliation: Department of Neurology, Westfries Gasthuis, Maelsonstraat 3, 1624, NP, Hoorn, The Netherlands.
authors.forename: Taco
authors.initials: T
authors.lastname: van der Ree
authors.affiliation: Department of Neurology, Onze Lieve Vrouw Gasthuis, Oosterpark 9, 1091, AC, Amsterdam, The Netherlands.
authors.forename: Vincent I H
authors.initials: VI
authors.lastname: Kwa
authors.affiliation: Department of Neurology, Sint Lucas Andreas Ziekenhuis, Jan Tooropstraat 164, 1061, AE, Amsterdam, The Netherlands.
authors.forename: Renske M
authors.initials: RM
authors.lastname: Van den Berg-Vos
authors.affiliation: Department of Neurology, Academic Medical Center, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
authors.forename: Yvo B
authors.initials: YB
authors.lastname: Roos
authors.affiliation: Department of Neurology, Academic Medical Center, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands. j.coutinho@amc.nl.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Coutinho
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D061665:Time-to-Treatment
chemical_list: D005343:Fibrinolytic Agents
keywords: Door-to-needle time; High-volume; Hospitals; Stroke; Thrombolytic therapy