Introduction: The clinical benefit of intravenous thrombolysis (IV tPA) in acute ischemic stroke (AIS) is time dependent. Achieving a door-to-needle time (DTN) ≤60 minutes for IV tPA is a quality care measure endorsed by the National Quality Forum.
Methods: A total of 433,410 AIS admissions from 520 participated hospitals were identified in the Paul Coverdell National Acute Stroke Program (PCNASP) from 2008-2016. We assessed the overall temporal changes in DTN time and examined the factors associated with DTN ≤60 minutes by performing generalized estimating equations (GEE) modeling. The adjusted odds ratio (AOR) and 95% confidence interval (CI) were obtained.
Results: There were total of 33,456 (8%) patients who received IV tPA (transfers excluded) with available door to needle times. The percentage of AIS patients who received IV tPA increased from 4.8% in 2008 to 9.8% in 2016, and significant increases were also observed among those with DTN ≤45 minutes (11.6% in 2008 to 35.1% in 2016, p<0.001), as well as with DTN ≤60 minutes (26.9% in 2008 to 60.5% in 2016, p<0.001) (Table). Patients aged 55-84 years were more likely to receive IV tPA within 60 minutes as compared to those aged 18-54. Arrival by EMS was a significant factor associated with DTN ≤60 minutes (AOR: 1.84, 95%CI: 1.74-1.95). Conversely, women, black patients as compared to white, patients with mild stroke (NIHSS score 0-4) as compared to ≥25, and patients with medical history of diseases associated with stroke were less likely to achieve DTN ≤60 minutes.
Conclusion: Rapid improvements on DTN time were observed in PCNASP. Opportunities for quality improvements within these disparities should be further examined.