analysis demonstrates that a minority of patients treated with intravenous tPA receive this therapy within 60 minutes of arrival
those... arriving during off-hours were particularly less likely to receive timely care
hospitals with less experience in providing tPA to ischemic stroke patients were less likely to provide thrombolytic therapy within 60 minutes
there was no evidence of worse in-hospital outcomes or increased bleeding complications from tPA for patients with door-to-needle times of less that 60 minutes compared with those with door-to-needle times of greater than 60 minutes
in-hospital mortality was lower among those patients treated in a more timely fashion, even after extensive risk adjustment.
This last point hits home, because hospital mortality rates for acute stroke are by far the highest in the State of California and my home region's rates are even worse. I agree with the authors that these findings lend support for a targeted initiative to shorten door-to-needle times in acute ischemic stroke to maximize the clinical benefit and a few of us are attempting to do just this for our the tri-county region. Stay tuned!