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Association between i.v. thrombolysis volume and door-to-needle times in acute ischemic stroke

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 consecuti...

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Autores principales: Groot, Adrien E., van Schaik, Ivo N., Visser, Marieke C., Nederkoorn, Paul J., Limburg, Martien, Aramideh, Majid, de Beer, Frank, Zwetsloot, Caspar P., Halkes, Patricia, de Kruijk, Jelle, Kruyt, Nyika D., van der Meulen, Willem, Spaander, Fianne, van der Ree, Taco, Kwa, Vincent I. H., Van den Berg-Vos, Renske M., Roos, Yvo B., Coutinho, Jonathan M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4826653/
https://www.ncbi.nlm.nih.gov/pubmed/26946499
http://dx.doi.org/10.1007/s00415-016-8076-5
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author Groot, Adrien E.
van Schaik, Ivo N.
Visser, Marieke C.
Nederkoorn, Paul J.
Limburg, Martien
Aramideh, Majid
de Beer, Frank
Zwetsloot, Caspar P.
Halkes, Patricia
de Kruijk, Jelle
Kruyt, Nyika D.
van der Meulen, Willem
Spaander, Fianne
van der Ree, Taco
Kwa, Vincent I. H.
Van den Berg-Vos, Renske M.
Roos, Yvo B.
Coutinho, Jonathan M.
author_facet Groot, Adrien E.
van Schaik, Ivo N.
Visser, Marieke C.
Nederkoorn, Paul J.
Limburg, Martien
Aramideh, Majid
de Beer, Frank
Zwetsloot, Caspar P.
Halkes, Patricia
de Kruijk, Jelle
Kruyt, Nyika D.
van der Meulen, Willem
Spaander, Fianne
van der Ree, Taco
Kwa, Vincent I. H.
Van den Berg-Vos, Renske M.
Roos, Yvo B.
Coutinho, Jonathan M.
author_sort Groot, Adrien E.
collection PubMed
description 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.
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spelling pubmed-48266532016-04-20 Association between i.v. thrombolysis volume and door-to-needle times in acute ischemic stroke Groot, Adrien E. van Schaik, Ivo N. Visser, Marieke C. Nederkoorn, Paul J. Limburg, Martien Aramideh, Majid de Beer, Frank Zwetsloot, Caspar P. Halkes, Patricia de Kruijk, Jelle Kruyt, Nyika D. van der Meulen, Willem Spaander, Fianne van der Ree, Taco Kwa, Vincent I. H. Van den Berg-Vos, Renske M. Roos, Yvo B. Coutinho, Jonathan M. J Neurol Original Communication 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. Springer Berlin Heidelberg 2016-03-05 2016 /pmc/articles/PMC4826653/ /pubmed/26946499 http://dx.doi.org/10.1007/s00415-016-8076-5 Text en © The Author(s) 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Communication
Groot, Adrien E.
van Schaik, Ivo N.
Visser, Marieke C.
Nederkoorn, Paul J.
Limburg, Martien
Aramideh, Majid
de Beer, Frank
Zwetsloot, Caspar P.
Halkes, Patricia
de Kruijk, Jelle
Kruyt, Nyika D.
van der Meulen, Willem
Spaander, Fianne
van der Ree, Taco
Kwa, Vincent I. H.
Van den Berg-Vos, Renske M.
Roos, Yvo B.
Coutinho, Jonathan M.
Association between i.v. thrombolysis volume and door-to-needle times in acute ischemic stroke
title Association between i.v. thrombolysis volume and door-to-needle times in acute ischemic stroke
title_full Association between i.v. thrombolysis volume and door-to-needle times in acute ischemic stroke
title_fullStr Association between i.v. thrombolysis volume and door-to-needle times in acute ischemic stroke
title_full_unstemmed Association between i.v. thrombolysis volume and door-to-needle times in acute ischemic stroke
title_short Association between i.v. thrombolysis volume and door-to-needle times in acute ischemic stroke
title_sort association between i.v. thrombolysis volume and door-to-needle times in acute ischemic stroke
topic Original Communication
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4826653/
https://www.ncbi.nlm.nih.gov/pubmed/26946499
http://dx.doi.org/10.1007/s00415-016-8076-5
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