Deans' stroke musings: Optimizing Stroke Pathways: An Observational Audit of Door-to-CT Time, Thrombolysis, and Clinical Outcomes

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Friday, November 21, 2025

Optimizing Stroke Pathways: An Observational Audit of Door-to-CT Time, Thrombolysis, and Clinical Outcomes

You didn't even measure the most important outcome! 100% RECOVERY! Is everyone there that BLITHERINGLY STUPID?

Optimizing Stroke Pathways: An Observational Audit of Door-to-CT Time, Thrombolysis, and Clinical Outcomes

Zobia Farrukh • Muhammad Umer Younas • Abdullah Yousaf • Sabih Nofal • Zarghoona Kamal • Burhan Anjum

Published: November 17, 2025

DOI: 10.7759/cureus.97118

Open Access

Peer-Reviewed

Cite this article as: Farrukh Z, Younas M, Yousaf A, et al. (November 17, 2025) Optimizing Stroke Pathways: An Observational Audit of Door-to-CT Time, Thrombolysis, and Clinical Outcomes. Cureus 17(11): e97118. doi:10.7759/cureus.97118

Abstract

Background

Stroke is a leading cause of disability and mortality worldwide, where timely intervention is crucial for favorable outcomes. This study aimed to evaluate door-to-CT time performance, eligibility for intravenous thrombolysis, and associated clinical outcomes in patients with acute stroke.

Methodology

This prospective observational study was conducted at Shalamar Hospital, Lahore, Pakistan, from February 2023 to February 2025. A total of 310 consecutive patients presenting with acute stroke symptoms were enrolled. Door-to-CT time, thrombolysis eligibility, and treatment details were recorded. Clinical outcomes were assessed at discharge using the modified Rankin scale (mRS).

Results

A total of 310 patients with clinically suspected stroke were enrolled in the study. The mean age of the patients was 61.4 ± 12.6 years, with 182 (58.7%) being male. Hypertension (225, 72.6%) and diabetes mellitus (138, 44.5%) were the most frequent comorbidities. A total of 201 (64.8%) patients underwent CT scanning within 25 minutes of arrival (door-to-CT time). Thrombolysis eligibility was established in 118 (38.1%) patients, of whom 96 (31.0% of the cohort) received intravenous recombinant tissue plasminogen activator (rt-PA). The mean door-to-needle time was 52.7 ± 14.6 minutes, with 71 (74%) of the treated patients achieving the <60-minute benchmark. Favorable outcomes (mRS score = 0-2) were observed in 50 (52.1%) thrombolysed patients compared to 71 (33.2%) non-thrombolysed patients (p < 0.01). Symptomatic intracerebral hemorrhage occurred in 6 (6.2%) treated patients, while overall in-hospital mortality was 34 (11.0%).

Conclusions

Achieving timely door-to-CT imaging significantly increases the likelihood of thrombolysis eligibility, while intravenous rt-PA improves functional outcomes with acceptable safety.