ORIGINAL RESEARCH article
Front. Stroke
Sec. Acute Stroke and Interventional Therapies
Volume 4 - 2025 | doi: 10.3389/fstro.2025.1583875
Improved Functional Outcomes and Cost Benefits of Door-to-Needle Time Under 30 Minutes in Acute Ischemic Stroke: An Observational Study
Provisionally accepted- 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
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Introduction: Intravenous thrombolysis(IVT) is cornerstone of acute ischemic stroke(AIS) recanalization therapy. Clinical guidelines advocate achieving Door-to-Needle(DTN) time of 60 minutes 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 centre from January 2017 to December 2023. Patients were stratified by DTN time into 4 groups: ≤30, 31-45, 46-60 and >60 minutes. 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 hospitalisation cost, symptomatic intracerebral haemorrhage(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 minutes 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 minutes. They also experienced 4-day shorter length of stay(LoS) until rehabilitation(p = 0.005) and 22.7% reduction in total hospitalisation costs(p = 0.004).Conclusions: This study suggests that DTN time of ≤30 minutes 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 30minute DTN goal in routine clinical practice.
Keywords: Stroke, ischemic stroke, thrombolysis, functional status, Outcome Assessment, Healthcare costs, Patient Outcome Assessment, outcome and process assessment
Received: 26 Feb 2025; Accepted: 29 Apr 2025.
Copyright: © 2025 Wang, Ying-Qiu, Yeo, Soon, Ng, Jing, Chan, Yeo, Chia, Widjaja, Wong, Lim, Kumari, Murphy, Teoh and Tan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Benjamin Yq Tan, Value Driven Outcomes Office, Academic Informatics Office, National University Health System, Singapore, Singapore
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