Factors affecting in-hospital delay of intravenous thrombolysis for acute ischemic stroke A retrospective cohort study

This study was designed to investigate the factors affecting the in-hospital delay of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS). Two hundred and forty-eight consecutive AIS patients treated with intravenous administration of alteplase in Gansu Provincial Hospital from December 2014 to August 2018 were enrolled retrospectively in this study. According to door-to-needle (DTN) time, the patients were divided into either a delay group (DTN time> 60minutes; n=184) or a non-delay group (DTN time <= 60minutes; n= 64). The baseline data, laboratory tests, onset-to-door (OTD) time, door-to-accepting time (DTA), door-to-imaging time (DTI), and decision-making time in both groups were recorded. Multivariate logistic analysis was performed to analyze the data. There were significant differences in previous history of cerebral ischemic attack, emergency system admission, education degree of decision makers, annual income, admission National Institutes of Health Stroke Scale (NIHSS), OTD time, DTA time, decision-making time between the 2 groups (all P<.05). Other baseline data and clinical features showed no significant difference between 2 groups (P>.05). Multivariate logistic regression analysis revealed that the risk of in-hospital delay was lower for the higher NIHSS score (OR=0.775, 95% CI: 0.644-0.933, P=.007), the longer OTD time (OR=0.963, 95% CI: 0.937-0.991, P=.010), the shorter decision-making time (OR=1.224, 95% CI: 1.004-1.492, P=.045). This study suggested that NIHSS score, OTD time and decision-making time are the independent factors affecting the in-hospital delay of IVT for AIS.