To determine whether the number of cases receiving tPA and corresponding door to needle time (DTN) is impacted by comprehensive stroke center status.

DTN has also been demonstrated to be one of the strongest predictors of outcome regardless of the time since symptom onset. Stroke systems have been developed to address the major limitations to timely recognition of stroke symptoms and prompt administration of r-tPA to eligible patients. A comprehensive stroke center (CSC) may have improved door to needle times and percentage of patients treated from a variety of factors, including increased education of physicians and allied health personnel, as well as increased availability of expert opinion. In August 2017, out institution received CSC certification. We sought to determine whether this impacted the number of tpa cases or the DTN.

This is a retrospective quality assessment that examines the number of tpa cases and the corresponding DTN times. We compared two cohorts of patients who presented in the year before after receiving accreditation as a CSC. Data on total number of stroke patients, number of patients treated with r-tPA, and DTN were analyzed for differences. 

Prior to CSC designation, our average DTN times were 92, 67, and 61 minutes for the prior 3 years, with the number of t-pa cases being 22, 43 and 56. In the year that CSC designation was received, the average DTN was 54 minutes (goal= 60 minutes or less), and the number of tpa cases was 56. Looking at just the year before and after CSC designation (2016 and 2018), the DTN was significantly shorter (61 vs. 39 minutes, p<0.0001, z test for proportions).

Having CSC designation appears to be significantly associated with higher number of t-pa cases and shorter door to needle times