In-hospital delays in stroke thrombolysis: every minute counts

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MARC

Darehed, David,1986-Umeå University,Umeå universitet,Avdelningen för medicin (author)

In-hospital delays in stroke thrombolysis : every minute counts

Article/chapterEnglish2020

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American Heart Association,2020
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LIBRIS-ID:oai:DiVA.org:umu-168612
https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-168612URI
https://doi.org/10.1161/STROKEAHA.120.029468DOI
https://lup.lub.lu.se/record/0225815b-bdf5-4647-ab9a-d5dbcc55c102URI

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Language:English
Summary in:English

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Subject category:ref swepub-contenttype
Subject category:art swepub-publicationtype

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Originally published in thesis in manuscript form.
Background and Purpose: Intravenous thrombolysis is a well-established treatment for acute ischemic stroke. Our aim was to quantify the effect of each minute delay in door-to-needle time (DNT) on 90-day survival, intracerebral hemorrhagic complication <36 hours, and functional outcomes at 3 months, in routine clinical practice.Methods: Our nationwide registry-based study included 14 132 adult patient admissions with ischemic stroke receiving intravenous thrombolysis from 2010 to 2017. Outcomes were analyzed using multivariable logistic regression, adjusting for potential confounders.Results: Median DNT was 47 minutes, with an improvement from 65 to 38 minutes during the study. Median age was 74 years, and median National Institutes of Health Stroke Scale 8 points. We found a significant impact of each minute delay in DNT with reduced odds of survival by 0.6%, increased odds of intracerebral hemorrhagic and worse activities of daily living by 0.3%, and worse living conditions and mobility by 0.4%.Conclusions: Improving DNT is a key factor in achieving good outcomes after stroke. We estimate that in Sweden alone in 2017, compared with 2010, the shorter DNT achieved have saved 38 lives, avoided 8 intracerebral hemorrhagic transformations, and spared, respectively, 36, 51, and 52 patients from a worsening in activities of daily living, living conditions, and mobility. DNT is sensitive for interventions and should be targeted in quality improvement efforts.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Neurologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Neurology hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Hälsovetenskap Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi hsv//swe
MEDICAL AND HEALTH SCIENCES Health Sciences Public Health, Global Health, Social Medicine and Epidemiology hsv//eng
activities of daily living
mortality
quality improvement
survival
thrombolysis
activities of daily living
mortality
quality improvement
survival
thrombolysis

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Blom, MathiasLund University,Lunds universitet,Medicin, Lund,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Medicine, Lund,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine(Swepub:lu)med-mbo (author)
Glader, Eva-Lotta,1972-Umeå University,Umeå universitet,Avdelningen för medicin(Swepub:umu)evaglr96 (author)
Niklasson, JohanUmeå University,Umeå universitet,Geriatrik(Swepub:umu)joni0103 (author)
Norrving, BoLund University,Lunds universitet,Klinisk strokeforskning,Forskargrupper vid Lunds universitet,Stroke policy och kvalitetsregisterforskning,Clinical Stroke Research Group,Lund University Research Groups,Stroke policy and quality register research(Swepub:lu)neur-bno (author)
Eriksson, Marie,ProfessorUmeå University,Umeå universitet,Statistik(Swepub:umu)maer0004 (author)
Umeå universitetAvdelningen för medicin (creator_code:org_t)

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In:Stroke: American Heart Association51:8, s. 2536-25390039-24991524-4628

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