Alireza Noorian, MD

Bray BD, Campbell J, Geoffrey CC, Hoffman A, Tyrrell PJ, Wolfe CDA, et al. Bigger, Faster?: Associations Between Hospital Thrombolysis Volume and Speed of Thrombolysis Administration in Acute Ischemic Stroke. Stroke. 2013

Thrombolysis with tissue plasminogen activator (tPA) has been shown to improve the outcome when given within 4.5 hours following the symptom onset in acute ischemic stroke, the faster  given to the patient, the higher the chance of reaching better outcomes. In addition to pre-hospital delays, the time period from patient arrival to the hospital to the time tPA administration is started (arrival-tPA time), is affected by the hospital pathways in identification of stroke, investigation and initiation of treatment. There have been very few studies on the hospital characteristics and their rapidity and efficiency in shortening arrival-tPA times.

Bray et al, studied the association between hospital thrombolysis volume and arrival-tPA time. The study was performed through reviewing data from consecutive acute stroke patients in the Stroke Improvement National Audit Programme (SINAP), a prospective database from 106 UK hospitals. The hospital thrombolysis volume per year was categorized into three groups of low (0-24), medium(25-49) and high (≥50).

The study has demonstrated that the thrombolysis rate was higher in higher volume hospitals and the high volume centers achieved the quickest arrival to scanner and arrival-tPA times, while there was no difference between low and medium volume hospitals, suggestive of a potential threshold effect. There was no difference in complication rates suggesting that faster times were not at the expense of patient safety.   

In conclusion, they suggest that concentrating stroke thrombolytic services into a smaller number of higher volume centers, can potentially improve treatment times. This is an important implication for configuration of stroke care networks in the community and certification processes.