Disparities and Trends in Door-to-Needle Time

Abstract

Background and Purpose In the US, about half of acute ischemic stroke patients treated with tissue plasminogen activator (tPA) receive treatment within 60 minutes of hospital arrival. We aimed to determine the proportion of patients receiving tPA within 60 minutes (DTNT≤60) and 45 minutes (DTNT≤45) of hospital arrival by race/ethnicity and sex and to identify temporal trends in DTNT≤60 and DTNT≤45. Methods Among 65,654 AIS admissions in the NINDS-funded FL-PR Collaboration to Reduce Stroke Disparities (CReSD) Study from 2010–2015, we included 6,181 IV tPA-treated cases (9.4%). Generalized estimating equations were used to determine predictors of DTNT≤60 and DTNT≤45. Results DTNT≤60 was achieved in 42% and DTNT≤45 in 18% of cases. After adjustment, women less likely received DTNT≤60 (OR=0.81, 95% CI 0.72–0.92) and DTNT≤45 (OR=0.73 95% CI 0.57–0.93). Compared to whites, Blacks less likely had DTNT≤45 during off hours (OR= 0.68, 95% CI 0.47–0.98). Achievement of DTNT≤60 and DTNT≤45 was highest in South Florida (50%, 23%) and lowest in West Central Florida (28%, 11%). Conclusions In the FL-PR Collaboration to Reduce Stroke Disparities, achievement of DTNT≤60 and DTNT≤45 remains low. Compared to Whites, Blacks less likely receive tPA treatment within 45 minutes during off hours. Treatment within 60 and 45 minutes is lower in women compared to men and lowest in West Central Florida compared to other Florida regions and Puerto Rico. Further research is needed to identify reasons for delayed thrombolytic treatment in women and Blacks and factors contributing to regional disparities in DTNT.

Determinants and Temporal Trends of Dual Antiplatelet Therapy After Mild Noncardioembolic Stroke

“…13 Furthermore, the FSR identified that women and non-Hispanic Black individuals were more likely to receive delayed acute stroke care including longer door-to-needle and door-to-CT times. 20,21 Our findings add to the aforementioned data showing that women and minority groups tend to receive suboptimal stroke care, and suggest that antiplatelet therapy selection in the acute phase may contribute further to the higher readmission and mortality rates reported in these populations. 22,23 Quality improvement interventions have shown to be effective improving adherence to stroke care performance metrics and to reduce disparities.…”

Underutilization of Endovascular Therapy in Black Patients With Ischemic Stroke: An Analysis of State and Nationwide Cohorts

“…Acute care metrics including door to needle time have been shown to differ according to race, with many studies showing longer door to needle time in Black compared with White patients. 29,30 Other studies have shown delayed wait times after hospital arrival for Black and Hispanic patients compared with White patients. 31,32 Further study of the role of structural racism and implicit bias on under-utilization of EVT for ischemic stroke patients is needed.…”

Temporal trends in reperfusion therapy for patients with acute ischemic stroke

“… 13 The PHANTOM study in Berlin demonstrated that the use of an ambulance‐based CT scanner followed by thrombolysis was safe and significantly increased the thrombolysis rate (32.6% vs 21% for standard care) and reduced the alarm‐to‐treatment time by a mean of 25 minutes. 14 The second solution could be to reduce the DTN time via a further decrease in the DIT, which was still longer than 25 minutes for more than half of the patients. Our results contrasted with those of interventional and observational studies, which reported a consistent decrease in the DIT.…”