Factors influencing door-to-imaging time: analysis of the safe implementation of treatments in Stroke-EAST registry

J Stroke Cerebrovasc Dis. 2014 Sep;23(8):2122-2129. doi: 10.1016/j.jstrokecerebrovasdis.2014.03.019. Epub 2014 Aug 6.


Background: Brain imaging is logistically the most difficult step before thrombolysis. To improve door-to-needle time (DNT), it is important to understand if (1) longer door-to-imaging time (DIT) results in longer DNT, (2) hospitals have different DIT performances, and (3) patient and hospital characteristics predict DIT.

Methods: Prospectively collected data in the Safe Implementation of Treatments in Stroke-EAST (SITS-EAST) registry from Central/Eastern European countries between 2008 and 2011 were analyzed. Hospital characteristics were obtained by questionnaire from each center. Patient- and hospital-level predictors of DIT of 25 minutes or less were identified by the method of generalized estimating equations.

Results: Altogether 6 of 9 SITS-EAST countries participated with 4212 patients entered into the database of which 3631 (86%) had all required variables. DIT of 25 minutes or less was achieved in 2464 (68%) patients (range, 3%-93%; median, 65%; and interquartile range, 50%-80% between centers). Patients with DIT of 25 minutes or less had shorter DNT (median, 60 minutes) than patients with DIT of more than 25 minutes (median, 86 minutes; P < .001). Four variables independently predicted DIT of 25 minutes or less: longer time from stroke onset to admission (91-180 versus 0-90 minutes; odds ratio [OR], 1.6; 95% confidence interval [CI], 1.3-1.8), transport time of 5 minutes or less (OR, 2.9; 95% CI, 1.7-4.7) between the place of admission and a computed tomography (CT) scanner, no or minimal neurologic deficit before stroke (OR, 1.3; 95% CI, 1.02-1.5), and diabetes mellitus (OR, .8; 95% CI, .7-.97).

Conclusions: DIT should be improved in patients arriving early and late. Place of admission should allow transport time to a CT scanner under 5 minutes.

Keywords: Door-to-imaging time; acute stroke; door-to-needle time; imaging; ischemic stroke; thrombolysis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Brain / diagnostic imaging
  • Brain / pathology*
  • Diagnostic Imaging / standards*
  • Early Diagnosis*
  • Female
  • Hospitalization
  • Hospitals
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Registries
  • Stroke / diagnosis*
  • Stroke / diagnostic imaging
  • Stroke / pathology
  • Surveys and Questionnaires
  • Time Factors
  • Tomography, X-Ray Computed