mQUALITY OF ACUTE STROKE CARE AT THE DEPARTMENT OF URGENT NEUROLOGY / UNIVERSITY CLINIC FOR NEUROLOGY: ANALYSIS OF PROCESS METRICS AND OUTCOES DURING THE FIRST HALF OF 2025
Keywords:
Stroke, Quality Improvement, Time-to-Treatment, Thrombolytic Therapy, ThrombectomyAbstract
Introduction: Rapid reperfusion improves acute stroke outcomes. Guidelines recommend intravenous thrombolysis (IVT) within 60 min in ≥ 75% of eligible patients and 45 min in ≥ 50%. Endovascular therapy (EVT) should start within 90 min, with brain imaging completed in ≤ 25 min and interpreted in ≤ 45 min. This study assessed local compliance during early 2025.
Aim: To compare acute stroke process metrics, treatment rates, and outcomes between Q1 and Q2 2025 at the Department of Urgent Neurology, University Clinic for Neurology in Skopje, and benchmark against standards.
Material and methods: We retrospectively analyzed hospital and RES-Q registry data for all acute stroke admissions from January–June 2025. Variables included demographics, stroke type, time metrics, reperfusion rates, post-acute care indicators, and discharge outcomes.
Results: Q1: 79 patients (88.6% ischemic), median NIHSS 14, onset-to-door 180 min, door-to-imaging 26 min (48% ≤25 min). IVT in 29% (DTN 53 min: 57% ≤60 min, 43% ≤45 min); EVT 1% (door-to-groin 194 min). Q2: 28 patients (78.6% ischemic), NIHSS 13, onset-to-door 105 min, imaging 20 min. IVT rose to 35%, EVT to 15%, combined IVT+EVT 5%, recanalization 55%. DTN worsened to 87 min; door-to-groin improved to 93 min (meeting target). Carotid imaging rose from 65% to 83%.
Conclusion: In early 2025, imaging compliance and EVT use improved, with faster onset-to-door and door-to-groin times. However, DTN performance declined in Q2, and pre-hospital notification was lacking. Focused workflow optimization and EMS engagement are needed to achieve IVT benchmarks.
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Copyright (c) 2025 Anita Arsovska, Aleksandra Angelova, Jasmina Mitrevska Velkov, Jetmir Karimani, Glorija Gashpar, Shpresa Hasani, Petar Janevski, Teodora Kukoska, Bisera Cvetkovska, Dafina Alili, Bekim Axhami, Filip Dimovski, Filip Trpcheski
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