Factors that shorten or extend door to needle time in ischemic stroke patients based on different emergency systems: Belgian and Turkish models

Objective: Stroke is the second leading cause of death worldwide. Early initiation of treatment for ischemic stroke has beneficial effects on mortality and morbidity. This study was conducted to investigate the reasons that shorten or prolong the duration of treatment for acute ischemic stroke in different emergency systems. Materials and Methods: A retrospective review of medical records of patients with acute ischemic stroke who were referred to the Emergency Department of Antwerp University Hospital (UZA) and Cliniques Universitaires Saint-Luc (UCL) in Belgium and also Akdeniz University Hospital (AU) and Karadeniz Technical University Hospital (KTU) in Turkey between 01.01.2016-31.12.2017. The stroke protocols in use at four hospitals were created and their characteristics were examined. Results: Among the patients admitted to the ED by ambulance, the Door-to-CT time of patients in Belgium was longer than those in Turkey, but the duration of CT-to-IVT, Door-to-IVT, and Onset-to-IVT were shorter than the patients in Turkey (p<0.001, p<0.001, p<0.001, p=0.019 respectively). There was no difference between countries in terms of CT-to-EVT, Door-to-EVT and Onset-to-EVT times. Door-to-CT time was shorter in the center with CT in the ED than those outside the ED. Onset-to-Door time, Door-to-CT time, Door-to-IVT time, and Onset-to-IVT time were shorter in patients in Belgium who came to the hospital via MUG/SMUR than self-presenting patients and ambulance patients (p=0.008, p<0.001, p=0.002, p=0.016 respectively). The patients with the shortest CT-to-IVT time were those who received thrombolytic therapy in the CT unit (15 min. IQR=14). Conclusion: According to the results, the factors that enable the thrombolytic treatment to be started earlier in ischemic stroke patients are the use of the MUG/SMUR system, use of the stroke code, positioning the CT unit in the ED, starting the thrombolytic treatment in the CT unit and applying thrombolytic treatment in the first hospital. Keywords: Ischemic Stroke, Gate Needle Time, Stroke Protocol, Belgium, Turkey