Ali Saad, MD

Strbian D, Ahmed N, Wahlgren N, Lees KR, Toni D, Roffe C, et al. Trends in Door-to-Thrombolysis Time in the Safe Implementation of Stroke Thrombolysis Registry: Effect of Center Volume and Duration of Registry Membership. Stroke. 2015

It seems intuitive that the longer you do a certain process and the more you see of a disease, the better you get at it.

This study looked at 44,359 patients in the SITS (safe implementation of stroke thrombolysis) registry in Europe from 2002-2011 and questioned whether the year a center joined the registry and the number of patients seen per year correlated with DTN (door to needle time). Mean DTN was 73 min overall. Centers that joined in 2003-2005 had a mean DTN of 68min while those who joined in 2006-2009 had a mean DTN of 72 min. Centers that saw >100 patients also had improved times and this variable actually had a more robust effect than the year the center joined the registry. Centers treating 75-100 patients per year who joined SITS early experienced a drop from 50 minutes in 2003 to 30 minutes in 2008. Although the results are significant, the only centers that saw robust drops in mean DTN were the minority that saw a large number of patients. 

Limitations of the study include not being able to perform a subgroup analysis of type of stroke center (primary, secondary, tertiary). Only 5 centers saw 100 or more patients per year. The year a center joined the SITS registry may not necessarily correlate with the experience of a center as they may very well have been practicing for years before officially joining. Outcome measures and safety data were also not mentioned. The study is biased in that centers had to opt into the registry on a voluntary basis.

How does this paper change my practice? If i had a stroke in Europe, I MIGHT (but not necessarily) go to the largest stroke center even it’s a few minutes further away than a smaller one that’s close.