Abstract
<title>Abstract</title> <p> <bold>Background</bold> Stroke unit certification was established in Germany to ensure standardized, guideline-adherent and quality-assured care for patients with acute ischemic stroke. However, real-world evidence remains limited that treatment quality is superior in certified institutions. In this analysis we focused on potential differences between certified and non-certified institutions concerning various aspects of intravenous thrombolysis. <bold>Methods</bold> We conducted a retrospective registry-based analysis using data from the Hesse State Working Group on Quality Assurance (LAGQH) registry <italic>Acute Stroke Treatment in Hesse (SA_HE)</italic> between 2021 and 2024. Associations between stroke unit certification status, intravenous thrombolysis utilization, and process quality indicators of recanalization therapies were assessed using bivariate analyses and multivariable logistic regression models. <bold>Results</bold> A total of 59,514 patients with acute ischemic stroke were included. Intravenous thrombolysis within 4.5 hours after symptom onset was performed significantly more often in certified stroke units than in non-certified hospitals (pSUs: OR 1.90, 95% CI 1.68–2.14; cSUs: OR 1.87, 95% CI 1.67–2.09; both p < 0.001). Certified stroke units achieved guideline-recommended targets more often, including a door-to-needle time ≤60 minutes (pSUs: OR 3.15, 95% CI 2.49–3.99; cSUs: OR 2.49, 95% CI 2.03–3.06; both p < 0.001) and a door-to-needle time ≤30 minutes (pSUs: OR 1.56, 95% CI 1.31–1.85; cSUs: OR 2.15, 95% CI 1.83–2.53; both p < 0.001). While thrombolysis rates within the conventional treatment window were comparable between pSUs and cSUs, cSUs demonstrated higher rates of thrombolysis in the extended treatment window (4.5–24 hours) and more frequently achieved very short door-to-needle times. <bold>Conclusions</bold> Stroke unit certification was associated with a more frequent use of intravenous thrombolysis and shorter door-to-needle times. These findings highlight the importance of certification in achieving guideline-concordant treatment goals and support the implementation of certification-based quality assurance systems. </p>