Impact of a Dedicated Trauma Centre Opening on the Intravenous Thrombolysis Pathway for Acute Ischemic Stroke: A Single-Centre Before-and-After Observational Study from the University Hospital of Casablanca
Background and Aims: Stroke is a leading cause of death and disability worldwide, and the benefit of intravenous thrombolysis is critically time-dependent. Organisational reforms within stroke pathways have been shown to shorten treatment delays and improve patient selection. We assessed the impact of the opening of a dedicated trauma centre at the University Hospital of Casablanca on the characteristics of patients admitted to the thrombolysis alert pathway, in-hospital workflow times, imaging strategy, and intravenous thrombolysis rates. Methods: This was a single-centre, observational, before-and-after study including 403 consecutive patients admitted to the thrombolysis alert pathway at Ibn Rochd University Hospital, Casablanca, Morocco. Patients were divided into two groups according to the opening of the in-hospital trauma centre: a pre-opening period (September 2023-July 2024, n = 176) and a post-opening period (August 2024-September 2025, n = 227). Demographic data, vascular risk factors, baseline National Institutes of Health Stroke Scale (NIHSS), workflow intervals (onset-to-door, door-to-needle, onset-to-needle), initial imaging modality and intravenous thrombolysis rate were collected. Continuous variables were compared using the Student’s t-test and categorical variables using the χ2 test, with statistical significance set at p < 0.05. Results: Mean age was 65 ± 13.8 years, with a male predominance of 52%. Median admission NIHSS was 12. The dominant vascular topography was the middle cerebral artery territory (70%), followed by vertebrobasilar strokes (11%), stroke mimics (10%) and intracerebral haemorrhages (9%). After opening of the trauma centre, the use of magnetic resonance imaging as the first-line modality increased from 35% to 87%, while computed tomography decreased from 65% to 13% (p < 0.001). The intravenous thrombolysis rate increased significantly from 16% to 28% (p = 0.005). The onset-to-door interval decreased from 200 to 189 min (p = 0.19) and the onset-to-needle interval from 266 to 264 min (p = 0.93). The median door-to-needle time remained unchanged (70 vs 69 min) and above the 60-minute international benchmark. Conclusion: The opening of a dedicated trauma centre was associated with a significant shift towards MRI-based selection and a near doubling of the intravenous thrombolysis rate. However, the door-to-needle time did not improve, indicating that further internal workflow optimisation is now the priority to maximise the
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