Moges Seyoum Ido1, Ike S Okosun2, Rana Bayakly3, Lydia Clarkson3, James Lugtu3, Sanita Floyd3, Kerrie Krompf4, Michael Frankel4. 1. 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. 2. Division of Epidemiology & Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia. 3. Georgia Department of Public Health, Atlanta, Georgia. 4. Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, School of Medicine, Emory University, Atlanta, Georgia.
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.
BACKGROUND:Ischemic strokepatients 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 strokepatients 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: Sofia A Oluwole; Kefeng Wang; Chuanhui Dong; Maria A Ciliberti-Vargas; Carolina M Gutierrez; Li Yi; Jose G Romano; Enmanuel Perez; Brittany Ann Tyson; Maranatha Ayodele; Negar Asdaghi; Hannah Gardener; David Z Rose; Enid J Garcia; Juan Carlos Zevallos; Dianne Foster; Mary Robichaux; Salina P Waddy; Ralph L Sacco; Tatjana Rundek Journal: Stroke Date: 2017-07-13 Impact factor: 7.914