The aim of this study was to reduce the door-to-needle (DTN) time of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) through a comprehensive, hospital-based implementation strategy. The intervention involved a systemic literature review, identifying barriers to rapid IVT treatment at our hospital, setting target DTN time intervals, and building an evolving model for IVT candidate selection. The rate of non-in-hospital delay (DTN time ≤ 60 min) was set as the primary endpoint. A total of 348 IVT cases were enrolled in the study (202 and 146 in the pre- and post-intervention group, respectively). The median age was 61 years in both groups; 25.2% and 26.7% of patients in the pre- and post-intervention groups, respectively, were female. The post-intervention group had higher rates of dyslipidemia and minor stroke [defined as National Institutes of Health Stroke Scale (NIHSS) ≤ 3]; less frequent atrial fibrillation; higher numbers of current smokers, heavy drinkers, referrals, and multi-model head imaging cases; and lower NIHSS scores and blood sugar level (all P < 0.05). All parameters including DTN, door-to-examination, door-to-imaging, door-to-laboratory, and final-test-to-needle times were improved post-intervention (all P < 0.05), with net reductions of 63, 2, 4, 28, and 23 min, respectively. The rates of DTN time ≤ 60 min and onset-to-needle time ≤ 180 min were significantly improved by the intervention (pre: 9.9% vs. post: 60.3%; P < 0.001 and pre: 23.3% vs. post: 53.4%; P < 0.001, respectively), which was accompanied by an increase in the rate of neurological improvement (pre: 45.5% vs. post: 59.6%; P = 0.010), while there was no change in incidence of mortality or systemic intracranial hemorrhage at discharge (both P > 0.05). These findings indicate that it is possible to achieve a DTN time ≤ 60 min for up to 60% of hospitals in the current Chinese system, and that this logistical change can yield a notable improvement in the outcome of IVT patients.
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机译：这项研究的目的是通过基于医院的全面实施策略，减少急性缺血性卒中（AIS）中静脉溶栓（IVT）的门到针（DTN）时间。干预措施涉及系统的文献综述，确定在我们医院进行快速IVT治疗的障碍，设置目标DTN时间间隔以及为IVT候选人选择建立发展模型。非住院延迟率（DTN时间≤60分钟）被设置为主要终点。共有348例IVT病例参加了研究（干预前和干预后组分别为202和146）。两组的中位年龄均为61岁。干预前和干预后组的女性分别为25.2％和26.7％。干预后组的血脂异常和轻度卒中发生率较高[定义为美国国立卫生研究院卒中量表（NIHSS）≤3]；心房颤动的频率降低；当前吸烟者，酗酒者，转诊和多模式头部影像学病例的数量增加；降低NIHSS分数和血糖水平（所有P <0.05）。干预后，所有参数（包括DTN，门到检查，门到成像，门到实验室以及最终测试到针头时间）均得到改善（所有P <0.05），净减少了63％， 2、4、28和23分钟。干预显着改善了DTN时间≤60分钟和进针时间≤180分钟的发生率（pre：9.9％vs. post：60.3％; P <0.001 and pre：23.3％vs. post：53.4％ ；分别为P <0.001）和神经系统改善率的提高（之前：45.5％对之后：59.6％； P = 0.010），而死亡率或系统性颅内出血的发生率没有变化放电时（均P> 0.05）。这些发现表明，在当前的中国系统中，多达60％的医院有可能实现DTN时间≤60分钟，并且这种后勤方面的改变可以使IVT患者的结局得到显着改善。
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