Time Equals Brain - Retrospective Analysis of Thrombolysis in Regional Australia to Determine Factors which Influence Door to Needle Time

A 3-year retrospective cohort analysis of all acute stroke admissions in Wollongong Hospital, a major regional referral centre in New South Wales, was completed to determine the causes of in-hospital delays for thrombolysis. Data collected included age, baseline National Institute of Health Stroke Scale (NIHSS) score, onset time, arrival time, CT imaging & reporting time and outcomes of the event. From 656 admissions, 70 cases of thrombolysis and 56 cases of endovascular thrombectomy (ECR) were recorded. The mean time from onset to arrival was 85 minutes, from arrival to CT was 31 minutes and from door to needle time (DTN) was 108 minutes. Multiple regression analysis revealed an inverse linear association between onset to arrival time and DTN. For every 30-minute delay in hospital arrival, there was a 13-minute reduction in DTN. Age, stroke severity and gender were not shown to impact treatment times. The results showed that there was a paradoxical association between arrival time and DTN. The cause for this was not clearly appreciable but, similar to previous studies, was likely due to a lack of urgency when initiating management when patients arrived sooner after symptom onset. In light of this, a pilot education protocol to promote the motto ‘time equals brain’ amongst stroke first responders is being implemented to aim to reduce DTN to less than 80 minutes in the Illawarra region.