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The Effect of Easily Implementable Changes to the “D's of Stroke Care” in Reducing Sex Disparity in Door-To-Needle Time Publisher Pubmed



Jameie M1 ; Jameie M1 ; Farahmand G3 ; Ilkhani S4 ; Magrouni H3 ; Ranjbar Z3 ; Heydari S3 ; Shahbazi M3 ; Kaeedi M3 ; Amani K3 ; Amiri R1 ; Alizade F3 ; Balali P1 ; Amanollahi M1 Show All Authors
Authors
  1. Jameie M1
  2. Jameie M1
  3. Farahmand G3
  4. Ilkhani S4
  5. Magrouni H3
  6. Ranjbar Z3
  7. Heydari S3
  8. Shahbazi M3
  9. Kaeedi M3
  10. Amani K3
  11. Amiri R1
  12. Alizade F3
  13. Balali P1
  14. Amanollahi M1
  15. Pourghaz B1
  16. Ghabaee M1, 3
Show Affiliations
Authors Affiliations
  1. 1. Iranian Center of Neurological Research, Neuroscience Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  2. 2. Tehran Heart Center, Cardiovascular Diseases Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  3. 3. Department of Neurology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  4. 4. Department of Surgery and Vascular Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Source: Neurologist Published:2023


Abstract

Background: Door-to-needle (DTN) is the duration between patient's arrival at the hospital and receiving intravenous thrombolysis in ischemic stroke settings, for which studies have reported delays in women. The “D's of stroke care” describes 8 steps (D1 to D8) in patients' time tracker. We implemented simple modifications to the “D's of stroke care” by splitting D4 and D6 steps into these substeps: patients' arrival to the emergency room (D4-A), early assessment by a neurologist (D4-B), neurologist decision on patient's eligibility to receive recombinant tissue plasminogen activator (D6-A), and patient's transfer to the stroke unit (D6-B). We evaluated the effect of these changes on reducing DTN time disparity between men and women. Methods: This study was conducted from September 2019 to August 2021, at a comprehensive stroke center. Patients were analyzed in 2 groups: group 1, before, and group 2, after using the modifications. Sex as the main variable of interest along with other covariates was regressed toward the DTN time. Results: In groups 1 and 2, 47 and 56 patients received intravenous thrombolysis, respectively. Although there was a significant difference in DTN ≤ 1 hour between women and men in group 1 (36% vs. 52%, P = 0.019), it was not significantly different in group 2 (P = 0.97). Regression analysis showed being female was a significant predictor of DTN > 1 hour in group 1 (adjusted odds ratio = 6.65, P = 0.02), whereas after using the modifications, sex was not a significant predictor for delayed DTN. Conclusions: Implementing these substeps reduced sex disparity in DTN time in our center. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
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