Stuck in time: Stroke centers make little headway in swift care

The needle for door-to-needle times for thrombolytic therapy in stroke patients hasn’t dropped much over a decade, according to a study published online March 31 in Stroke.

Treatment with thrombolysis for ischemic stroke patients can improve outcomes if administered soon after stroke onset. Daniel Strbian, MD, PhD, MSc, of Helsinki University Central Hospital in Finland, and colleagues reasoned that with experience, hospitals treating stroke patients would become more efficient and shorten their door-to-needle times.

To test that, they analyzed data in the Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis registry (SITS-ISTR) from 2002 to 2011. More than 750 centers in more than 40 countries participated in the registry.

Based on 44,359 patients with door-to-needle times, they calculated the median door-to-needle time was 67 minutes and the mean time was 73 minutes. Overall, the median time barely budged between 2003 (72 minutes) and 2011 (70 minutes).

Centers that joined the registry in 2003 reduced their median times from 72 minutes in 2003 to 59 minutes in 2011. Their overall time was eight minutes shorter than centers that came on board after 2003.

Those centers that handled more than 100 cases a year posted a steady decline in door-to-needle times, too, between 2002 and 2011. Centers with 75 to 99 cases a year also trimmed times, but the trajectory flattened out after 2008.   

“[O]nly minor overall improvements in [door-to-needle time] were observed during the first decade of the SITS registry,” Strbian et al wrote. “About experience, center volume is more important than the year of treatment.”

They recommended creating a project that targeted low-volume centers with the goal of helping them reduce their door-to-needle times.