Comparison of acute stroke care pathways and door-to-needle times in Belgian and Turkish university hospitals: A four-center retrospective study.

BACKGROUND: Timely intravenous thrombolysis (IVT) is essential for improving clinical outcomes in acute ischemic stroke. This study compared stroke management protocols in two Belgian and two Turkish university hospitals, focusing on the impact of different emergency care models and in-hospital pathways on door-to-needle (DTN) time. METHODS: A retrospective observational study was conducted across four centres (two in Belgium, two in Türkiye) between January 2016 and December 2017. Eligible adults (≥18 years) presented to the Emergency Department (ED) within 6 h of stroke onset or were referred for endovascular therapy. Demographics, National Institutes of Health Stroke Scale scores, prehospital transport type, Computer Tomography scanner (CT) location, and treatment details were collected. The primary outcome was DTN time. Secondary outcomes included door-to-CT time, IVT utilization, and 3-month functional status (mRS). RESULTS: 1034 patients with confirmed acute ischemic stroke were included. Median door-to-CT time was shortest in the Turkish centre with a CT scanner within the ED (17 vs 22-25 min, p < 0.001). However, Belgian hospitals achieved significantly shorter DTN times (median 33-41 vs 57-101 min in Turkish centres, p < 0.001). IVT and/or EVT usage was higher in Belgian (75.9%) than Turkish hospitals (45.9%). Three-month functional outcome (mRS 0-2) was slightly better in centres with lower baseline NIHSS scores; overall mortality rates were comparable (p > 0.05). CONCLUSION: Significant differences in DTN times were observed between EDs employing different models of care. In addition to physician-staffed prehospital care and direct IVT administration in the CT suite, locating the CT scanner within the ED was associated with shorter door-to-CT times. These findings can guide policymakers and clinicians to optimize stroke protocols.