Background: The benefits of intravenous tissue plasminogen activator (tPA) in acute ischemic stroke are time dependent and guidelines recommend an arrival to treatment initiation (door-toneedle) time of 60 minutes or less. Methods and Results: Data from acute ischemic stroke patients treated with tPA within 3 hours of symptom onset in 1082 hospitals participating in the Get With The Guidelines-Stroke Program from 4/1/2003 to 9/30/2009 were studied to determine frequency, patient and hospital characteristics, and temporal trends in patients treated with door-to-needle times ≤60 minutes. Among 25,504 ischemic stroke patients treated with tPA, door-to-needle time was ≤60 minutes in only 6790 (26.6%). Patient factors most strongly associated with door-to-needle time ≤60 minutes were younger age, male, white race, or no prior stroke. Hospital factors associated with ≤60 minute door-to-needle times included greater annual volumes of tPA treated stroke patients. The proportion of patients with door-to-needle times ≤60 minutes varied widely by hospital (0%
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