Department of Neurology, the First Affiliated Hospital of Chengdu Medical College, Chengdu, China.
The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.
Sci Rep. 2017 Oct 26;7(1):14168. doi: 10.1038/s41598-017-14164-8.
Door-to-needle time (DNT) is a key performance indicator for efficient use of intravenous thrombolysis in acute ischemic stroke (AIS). We aimed to determine whether DNT improved over time in the Enhanced Control of Hypertension and Acute Stroke Study (ENCHANTED) and the clinical predictors of DNT. Temporal trends in DNT were assessed across fourths of time since activation of study centers using generalized linear model. Predictors of long DNT (>60 min) were determined in logistic regression models. Overall mean DNT (min) was 71.8 (95% confidence interval [CI] 70.4-73.2), but decreased significantly over time (fourths): 77.9 (74.9-80.9), 69.3 (66.7-72.0), 69.1 (66.5-71.8) and 71.4 (68.7-74.2) (P for trend, 0.003). The reduction in DNT was particularly marked in China (P for trend, 0.001), but was not significant across the other participating countries (P for trend, 0.065). Independent predictors of long DNT were recruitment from China, short onset-to-door time, lower numbers of patients treated per center, higher diastolic blood pressure, off-hour admission, and absence of proximal clot occlusion. DNT in ENCHANTED declined progressively during the trial, especially in China. However, DNT in China is still longer than the key performance parameter of ≤60 minutes recommended in guidelines. Effective national programs are needed to improve DNT in China.
门到针时间（DNT）是急性缺血性脑卒中（AIS）中静脉溶栓有效利用的关键绩效指标。我们旨在确定增强控制高血压和急性脑卒中研究（ENCHANTED）中 DNT 是否随着时间的推移而改善，以及 DNT 的临床预测因素。使用广义线性模型评估 DNT 自研究中心激活以来的时间按四等分的趋势。在逻辑回归模型中确定长 DNT（>60 分钟）的预测因素。总体平均 DNT（分钟）为 71.8（95%置信区间[CI] 70.4-73.2），但随着时间的推移显著降低（四等分）：77.9（74.9-80.9），69.3（66.7-72.0），69.1（66.5-71.8）和 71.4（68.7-74.2）（趋势 P 值，0.003）。DNT 的减少在中国尤为明显（趋势 P 值，0.001），但在其他参与国家则不显著（趋势 P 值，0.065）。长 DNT 的独立预测因素是来自中国的招募、较短的发病到门时间、每个中心治疗的患者数量较少、较高的舒张压、非工作时间入院以及没有近端血栓闭塞。在试验期间，ENCHANTED 的 DNT 逐渐下降，尤其是在中国。然而，中国的 DNT 仍然长于指南推荐的关键绩效参数≤60 分钟。需要有效的国家计划来改善中国的 DNT。
