Available online 3 November 2022

The objectives were to analyze changes from 2012 to 2017 in different management times of stroke patients included in the Aquitaine stroke Observatory (ObA2). The studied times (onset-to-needle time-ONT, onset-to-door time-ODT, door-to-imaging time-DIT, door-to-needle time-DNT and imaging-to-needle time-INT) were described as median, interquartile ranges and proportion of patients within the recommended median time goals (ODT under 4 hours, DIT within 20 min; for thrombolyzed patients, DIT under 20 min and a ONT under 4:30) to be compared with an objective of 50% of patients within said time goal. Globally, ODT was 160 min, with 43.6% to 59.6% of patients within the ODT goal along the study period. With no improvement over time, the proportion of patients within the DIT goal stayed stable and at a low level (range: 5.5–7.0%) for all patients, decreasing from 25.2% to 11.4% for thrombolyzed patients. The proportion of thrombolyzed patients within the DNT goal varied from 15.1% to 30.3% during study period. These results highlight the urgent need for action to improve in-hospital management of stroke patients, focusing on delays between admission and imaging.

comprehensive stroke center

door-to-imaging time

door-to-needle time

imaging-to-needle time

intravenous thrombolysis

Aquitaine stroke Observatory

onset-to-door time

onset-to-needle time

primary stroke centers

primary care centers

target delays

This study was a descriptive analysis of onset-to-treatment times of stroke patients included in the ObA2 cohort, involving adult patients, living in metropolitan France, with recent stroke, admitted to any hospital in Aquitaine, a geographical region in South Western France, managing more than 30 stroke patients per year. Both patients with and without stroke alert were included. Patients with transient ischemic attack were excluded.

Were included ischemic stroke patients with brain imaging

Among 13,159 patients included in ObA2 during the study period, 5,234 were excluded (1,816 hemorrhagic strokes, 427 without brain imaging and 2,991 transferred patients), leaving 7,925 patients in the study sample; 1,582 of whom received IVT.

Mean age was 75.0 (standard deviation = 14.4) years and 56.2% (n = 4,453) of patients were male; 59.8% (n = 4,742) were hospitalized in the CSC, 26.2% (n = 2,075) in the two PSCs and 14.0% (n = 1,108) in the three PCCs (Table 1).

Median ODT dropped from 228 to 157 min

Our study shows three main results: i) most delays, particularly in-hospital ones, were above recommendations; ii) no improvement was observed over the six-year study period for most of them; iii) results were similar across the region.

In large-sample size observational studies, DNT is commonly reported to be within one hour for more than half of included patients [8], much higher than the 23.6% observed in the present study. For thrombolyzed patients, median DIT retrieved in the literature

The only funder of the ObA2 cohort is the Regional Health Agency: ARS Nouvelle-Aquitaine.

The authors declare that they have no competing interest.

We thank all actors of the ObA2 for their support.

There are more references available in the full text version of this article.

© 2022 Elsevier Masson SAS. All rights reserved.