Improved functional outcomes and cost benefits of door-to-needle time under 30 min in acute ischemic stroke: an observational study

WAY TOO SLOW; in mice you have to deliver in 3 minutes for full recovery!

In this research in mice the needed time frame for tPA delivery is 3 minutes for full recovery. What is your plan to accomplish that? Or are you ignoring that need?

Electrical 'storms' and 'flash floods' drown the brain after a stroke)

The latest here:

 Improved functional outcomes and cost benefits of door-to-needle time under 30 min in acute ischemic stroke: an observational study

Jia Dong James Wang1, Ying-Qiu Dong2, Joshua Y. P. Yeo3, Kevin Soon Hwee Teo3, Shiyang Ng3, Mingxue Jing3, Bernard P. L. Chan3, Leonard L. L. Yeo3, Magdalene L. J. Chia3, Louis Widjaja4, Lily Y. H. Wong3, Pamela Lim2, Shikha Kumari2, Diarmuid Murphy2, Hock-Luen Teoh3 and Benjamin Y. Q. Tan2*

1Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore

2Value Driven Outcomes Office, Academic Informatics Office, National University Health System, Singapore, Singapore

3Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore

4Department of Medical Affairs, National University Hospital, Singapore, Singapore

Edited by

Kersten Villringer, Charité University Medicine Berlin, Germany

Reviewed by

Alejandro Vargas, Rush University Medical Center, United States

Loïc Legris, Grenoble Institut Neurosciences, France

*Correspondence

Benjamin Y. Q. Tan, ben.tan@nus.edu.sg

Received 26 February 2025

Accepted 29 April 2025

Published 03 June 2025

Citation

Wang JDJ, Dong Y-Q, Yeo JYP, Teo KSH, Ng S, Jing M, Chan BPL, Yeo LLL, Chia MLJ, Widjaja L, Wong LYH, Lim P, Kumari S, Murphy D, Teoh H-L and Tan BYQ (2025) Improved functional outcomes and cost benefits of door-to-needle time under 30 min in acute ischemic stroke: an observational study. Front. Stroke 4:1583875. doi: 10.3389/fstro.2025.1583875

Introduction: Intravenous thrombolysis (IVT) is cornerstone of acute ischemic stroke(AIS) recanalization therapy. Clinical guidelines advocate achieving Door-to-Needle (DTN) time of 60 min or less, with recent evidence highlighting clinical advantages of even shorter DTN times. However, economic implications of reducing DTN time are less well-studied. This study aims to assess shorter DTN targets impact on clinical outcomes and healthcare costs.

Methods: This observational cohort study included consecutive patients with AIS treated with IVT in a comprehensive stroke center from January 2017 to December 2023. Patients were stratified by DTN time into 4 groups: ≤ 30, 31–45, 46–60, and >60 min. Multivariate linear and logistic regressions were performed to evaluate impact of DTN time on functional and financial outcomes, including modified Rankin's Score (mRS) at 3-months post-AIS, length-of-stay (LoS), total hospitalization cost, symptomatic intracerebral hemorrhage (SICH) and inpatient mortality.

Results: 1,146 patients (62.0% male) with mean age of 68.6 years were included. Overall, 47.6% of patients achieved a mRS of 0–2 at 3 months after AIS. Patients with DTN time of ≤ 30 min demonstrated higher odds of achieving mRS 0–2 at 3 months (OR 2.35, 95% CI 1.26–4.39) compared to DTN time of ≥60 min. They also experienced 4-day shorter length of stay (LoS) until rehabilitation (p = 0.005) and 22.7% reduction in total hospitalization costs (p = 0.004).

Conclusions: This study suggests that DTN time of ≤ 30 min is associated with improved functional outcomes and significant cost benefits, supporting consideration of this more aggressive target for acute stroke units. Further research is needed to assess feasibility and broader impact of implementing a 30-min DTN goal in routine clinical practice.

Keywords

stroke, ischemic stroke, thrombolysis, functional status, outcome