In his PhD thesis, Rajiv Advani has evaluated the effects of a mass media intervention and of implementing a rapid response treatment protocol for acute ischemic stroke.


  1. Door-to-needle time was markedly reduced following the implementation of a more streamlined protocol for treatment of ischemic stroke.
  2. A targeted mass media intervention resulted in an increased number of stroke patients being treated with intravenous thrombolysis.
  3. Stroke treatment within 60 minutes of symptom onset leads to excellent outcomes.


Thesis: Organisational and Informational Changes to Acute Onset Stroke Treatment Aimed at Increasing the Availability of Treatment and Improving Outcomes
Candidate: Rajiv Advani
Time: May 30, 2018 at 10:30
Place: Stavanger University Hospital, South Building: The Aula
Link to university website (in Norwegian)


(1) In 2009, Stavanger University Hospital changed their treatment protocol for patients presenting with acute onset ischemic stroke. Four years later, the number of patients receiving intravenous thrombolysis had increased by 27-fold.

Between 2003 and 2008, only 25 patients at the hospital were treated with thrombolysis. By 2012, the mean door-to-needle time improved from 73 minutes to 31 minutes, making it possible to give thrombolysis to a markedly higher number of patients within the time-frame of three hours.

(3) In-hospital mortality from acute ischemic stroke decreased continually from 6.7 % in 2009 to 3.0 % in 2015, following a dramatic reduction in door-to-needle time and an increased number of thrombolytic treatments. 634 patients were included in the analysis.

(4) The percentage of patients with acute stroke treated within the first hours of symptom onset rose from 2.2 % in 2009 to 14.5 % in 2015. All patients given thrombolytic treatment within this “golden hour” had excellent outcomes, irrespective of age and comorbidities.

(2) The number of suspected acute stroke admissions in Stavanger doubled following a regional stroke campaign in social media, newspapers and on television. This resulted in a marked increase in the rate of intravenous thrombolysis treatment. The effect, however, tapered off around six months after the end of the mass media intervention.

By performing 1400 telephone interviews, Advani and coworkers also revealed that the campaign had resulted in better recognition of stroke symptoms.


(1) Advani, R., Naess, H., & Kurz, M. W. (2014). Evaluation of the implementation of a rapid response treatment protocol for patients with acute onset stroke: can we increase the number of patients treated and shorten the time neededCerebrovascular diseases extra4(2), 115-121.

(2) Advani, R., Naess, H., & Kurz, M. (2016). Mass media intervention in Western Norway aimed at improving public recognition of stroke, emergency response, and acute treatmentJournal of Stroke and Cerebrovascular Diseases25(6), 1467-1472.

(3) Advani, R., Naess, H., & Kurz, M. W. (2016). Lower Door to Needle Times–Is it the Pace that Kills?[Version 2]Current Updates in Neurology and Neuroscience

(4) Advani, R., Naess, H., & Kurz, M. W. (2017). The golden hour of acute ischemic strokeScandinavian journal of trauma, resuscitation and emergency medicine25(1), 54.

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