Highlights
- •We implemented the strategic changes including the Helsinki thrombolysis model.
- •Phased strategic changes could reduce delay of tPA thrombolysis to 15 min.
- •Mild symptoms and anticoagulation were independent predictors for delay.
- •Simplification of brain imaging was a key strategy.
Abstract
Objectives
The present study aimed to determine whether phased changes in strategies including
the Helsinki model affect the delay of intravenous thrombolysis (IVT) using tissue
plasminogen activator (tPA) to treat acute ischemic stroke.
Method
We retrospectively studied 516 consecutive patients treated with IVT in our department
between October 2005 and December 2018. We implemented a system of hospital pre-notification
in 2005, when IVT was initially implemented at our center. We then improved the IVT
strategy by simplifying brain imaging (July 2011), premixing tPA (April 2014), locating
a blood cell counter in the emergency room (June 2015), manually administering a tPA
bolus before preparing a continuous infusion (January 2016), awarding a prize to members
of the acute stroke team (November 2016), and completing registration before arrival
and sending patients directly to computed tomography (February 2017). We analyzed
the effects of these strategic changes on annual median door-to-needle times (DTN).
Results
The DTN was annually reduced, from a median of 90 [interquartile range, 55–98] minutes
in 2006 to 15 [12–24.25] minutes in 2017. By 2017, 94% of patients were treated within
60 min of arrival. Multivariate logistic regression analysis revealed that initial
NIHSS score ≤ 4 (OR 2.67, 95% CI 1.3–5.7) and anticoagulation before onset (OR 6.00,
95% CI 2.47–14.58) were independently associated with 20 min or more of DTN in 186
patients treated from 2016 to 2018.
Conclusions
Phased strategic change to reduce the delay in delivering IVT reduced median DTN to
15 min at a single Japanese stroke center.
Keywords
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Article info
Publication history
Published online: June 13, 2019
Received in revised form:
June 10,
2019
Received:
December 4,
2018
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
