Dataset Information

Presentation outside office hours does not negatively influence treatment times for reperfusion therapy for acute ischemic stroke.

ABSTRACT:

Background

Treatment outside office hours has been associated with increased workflow times for intravenous thrombolysis (IVT) in acute ischemic stroke (AIS). Limited data suggest that this "off-hours effect" also exists for endovascular treatment (EVT). We investigated this phenomenon in a well-organized acute stroke care region in the Netherlands.

Methods

Retrospective, observational cohort study of consecutive patients with AIS who received reperfusion therapy in the Greater Amsterdam Area, consisting of 14 primary stroke centers and 1 comprehensive stroke center (IVT: 2009-2015, EVT: 2014-2017). Office hours were defined as presentation during weekdays between 8 AM and 5 PM, excluding National Festive days. Primary outcome was door-to-treatment time (door-to-needle [DNT] for IVT, door-to-groin [DGT] for EVT). For DGT, we used the door time of the first hospital. Other outcomes were in-hospital mortality, modified Rankin Scale (mRS) score at 90 days and symptomatic intracranial hemorrhage (sICH). We performed multivariable linear and logistic regression analyses and used multiple imputation to account for missing values.

Results

In total, 59% (2450/4161) and 61% (239/395) of patients treated with IVT and EVT, respectively, presented outside office hours. Median DNT was minimally longer outside office hours (32 vs. 30 min, p?=?0.024, adjusted difference 2.5 min, 95% CI 0.7-4.2). Presentation outside office hours was not associated with a longer DGT (median 130 min for both groups, adjusted difference 7.0 min, 95% CI -?4.2 to 18.1). Clinical outcome and sICH rate also did not differ.

Conclusion

Presentation outside office hours did not lead to clinically relevant treatment delays for reperfusion therapy in patients with AIS.

SUBMITTER: Groot AE

PROVIDER: S-EPMC7815598 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

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Publications

Presentation outside office hours does not negatively influence treatment times for reperfusion therapy for acute ischemic stroke.

Groot A E AE de Bruin H H Nguyen T T M TTM Kappelhof M M de Beer F F Visser M C MC Zwetsloot C P CP Halkes P H A PHA de Kruijk J J van der Meulen W D M WDM van der Ree T C TC Kwa V I H VIH van Schaik S M SM Hani L L van den Berg R R Sprengers M E S MES Roosendaal S D SD Emmer B J BJ Nederkoorn P J PJ Majoie C B L M CBLM Roos Y B W E M YBWEM Coutinho J M JM

Journal of neurology 20200731 1

<h4>Background</h4>Treatment outside office hours has been associated with increased workflow times for intravenous thrombolysis (IVT) in acute ischemic stroke (AIS). Limited data suggest that this "off-hours effect" also exists for endovascular treatment (EVT). We investigated this phenomenon in a well-organized acute stroke care region in the Netherlands.<h4>Methods</h4>Retrospective, observational cohort study of consecutive patients with AIS who received reperfusion therapy in the Greater Am ...[more]

PMID: 32737653

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Project description:BACKGROUND: The insula is a small but complex structure located in the depth of the sylvian fissure, covered by the frontal, parietal and temporal operculum. Ischemic strokes limited to the insula are rare and have not been well studied. Our objective is to better define the clinical presentation and outcome of insular ischemic strokes (IIS). METHODS: We reviewed the institutional prospective, consecutive stroke database from two centers to identify patients with IIS seen between 2008 and 2010. We also searched the Medline database using the keywords insula(r), infarction and stroke to identify previously published IIS cases confirmed by MRI. Minimal extension to an adjacent operculum or subinsular area was accepted. Clinicoradiological correlation was performed by distinguishing IIS involving the anterior (AIC) or posterior insular cortex (PIC). We collected clinical, demographic and radiological data. The outcome was determined using the modified Rankin Scale (mRS). RESULTS: We identified 7 patients from our institutions and 16 previously published cases of IIS. Infarcts were limited to the AIC (n = 4) or the PIC (n = 12) or affected both (n = 7). The five most frequent symptoms were somatosensory deficits (n = 10), aphasia (n = 10), dysarthria (n = 10), a vestibular-like syndrome (n = 8) and motor deficits (n = 6). A significant correlation was found between involvement of the PIC and somatosensory manifestations (p = 0.04). No other statistically significant associations were found. IIS presentation resembled a partial anterior circulation infarct (n = 9), a lacunar infarct (n = 2) or a posterior circulation infarct (n = 2). However, most cases presented findings that did not fit with these classical patterns (n = 10). At the 6 month follow up, mRS was 0 in 8/23 (35%) patients, 1-2 in 7/23 (30%) and unknown in 8/23 (35%). CONCLUSIONS: IIS presentation is variable. Due to the confluence of functions in a restricted region, it results in multimodal deficits. It should be suspected when vestibular-like or motor but especially somatosensory, speech or language disturbances are combined in the same patient. The outcome of IIS is often favorable. Larger prospective studies are needed to better define the clinical presentation and outcome of IIS.

Dataset Information

Presentation outside office hours does not negatively influence treatment times for reperfusion therapy for acute ischemic stroke.

Background

Methods

Results

Conclusion

Publications

Presentation outside office hours does not negatively influence treatment times for reperfusion therapy for acute ischemic stroke.

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