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Efficacy of Comprehensive Stroke Unit in Reducing Door to Needle Time; an Experience from South India

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Presented at

11th World Stroke Congress

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Abstract

Background: Door to needle time (DNT) provides valuable insight into local trends and is a measure of performance of an acute stroke unit. We aim to report DNT in our cohort of acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT) and its outcome. Methods: Patients with AIS treated with IVT in our stroke unit were reviewed. Their demographic and clinical characteristics including door to imaging time (DIT), DNT, and 3 month outcome (modified Rankin Scale) were noted. Factors associated with longer DNT and strategies to improve them were identified. Results: Of the 184 patients (Males = 67.9%), median DNT over 7 years was 40 minutes with significant decline over years. 28.3% patients were thrombolysed within 30 minutes with 90.2% patients within 60 minutes. Median DIT over 7 years was 15 minutes with DIT of < 25 minutes in 87.4% patients. 51.2% patients had a 4 point drop in NIHSS 24 hours post thrombolysis (IVT ± mechanical) with excellent outcome (mRS ≤2) noted in 67.6% patients at 3 months follow up. Symptomatic haemorrhage was noted in 9 patients (4.8%). The common patient related factors for delay in DNT were uncontrolled hypertension and delay in patient consent. Others were motor fluctuations and seizures. Logistic factors for delay were awaiting INR report and instillation of tPA in Stroke unit rather than in CT gantry. Conclusion: Our study reflects the successful establishment of a comprehensive stroke care unit in bringing down DNT to median of 30 minutes in resource poor country.

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