Impact of Stroke Center Certification on Thrombolysis Time Metrics in Telestroke Setting

Telemed J E Health. 2021 Feb;27(2):167-171. doi: 10.1089/tmj.2020.0020. Epub 2020 May 12.


Background: Previous studies have shown that primary stroke centers (PSCs) have shorter door to needle (DTN) time than non-PSCs hospitals. We aimed to validate these findings in a high-volume telestroke network. Methods: The prospectively maintained data on all consecutive stroke patients who received intravenous alteplase (tissue plasminogen activator [tPA]) between July 2016 and November 2019 through a large telestroke program in Southeast United States was reviewed. Wilcoxon Rank-sum (Mann-Whitney) test was used to compare median times between different groups. Multivariate logistic regression model was used to assess the association between presenting to PSC and having DTN ≤45 and ≤60 min. Results: During the study period, 1,517 patients received tPA, 874 (57.6%) at PSC sites. There were more white patients in the PSC group (64.3%) compared to non-PSC group (58%) (p < 0.001). Other characteristics were similar in patients in both groups. Time metrics were as follows, Door to telestroke page: 16 min versus 13 min (p < 0.001), telestroke page to tPA recommendation: 23 min versus 22 min (p = 0.975), tPA recommendation to tPA bolus administration: 13 min versus 10 min (p < 0.001), and DTN 58 min versus 49 min (p < 0.001) at non-PSC and PSC sites, respectively. On multivariate analysis, there were significantly higher odds for achieving a DTN ≤45 min (OR 2.8, 95% CI 1.8-4.4, p < 0.001) and DTN ≤60 min (OR 3, 95% CI 2.1-4.3, p < 0.001) in the PSC group. Conclusion: In our study, PSCs had better performance in the procedural metrics for tPA administration than non-PSCs in a large contemporary telestroke cohort.

Keywords: acute stroke management; joint commission; primary stroke center; stroke systems of care; telehealth; telemedicine; telestroke.

MeSH terms

  • Benchmarking
  • Certification
  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Retrospective Studies
  • Southeastern United States
  • Stroke* / drug therapy
  • Thrombolytic Therapy
  • Time Factors
  • Time-to-Treatment
  • Tissue Plasminogen Activator* / therapeutic use
  • Treatment Outcome


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator