SYSTEMIC FACTORS ASSOCIaTED WITH STROKE DOOR TO NEEDLE TIME: A COUNTRY WIDE ANALYSIS Introduction Pre-hospital, In-hospital, and individual clinical factors are associated with variation in door to needle (DTN) time in acute stroke, typically usually published from single large centres or multicentre registries. To date, no country-wide analysis of DTN time factors have been presented. Methods All Stroke patients treated with IV thrombolysis over 4 years (2013 to end of 2016) in a single county within the European Union were recorded prospectively, including patient demographics, prehospital care, thrombolysis rate and door to needle time. Logistic regression was performed to identify factors associated with DTN time. Results 1201 patients from 10556 stroke admissions (11.4%) were treated with IV thrombolysis in 5 health trusts. Median NIHSS was 10 (IQR 6-17). Median DTN time was 54 mins (IQR36-77) with 61% treated < 60 minutes from arrival at Emergency department. Nationally, both the arrival method at hospital (Pre-alert OR =5.2 CI3.5-8.1 P<0.001) and time of day (out of hours, n=650, OR 0.20 CI 0.22-0.38 P<0.001) were significant factors in determining DTN time. Variation in DTN between centres occurred but was not related to volume of stroke admissions. Conclusion Pre-hospital notification and time of day are associated with Stroke DTN time on a national level. Most stroke thrombolysis is delivered outside of normal working hours but these patients are more likely to experience treatment delays. Re-organisation of stroke services at a whole system level with emphasis on prehospital care and design of stroke teams are required to deliver quality and equitable care in acute stroke
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