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.

Workflow Intervals andOutcomesof Endovascular Treatment for Acute Large-Vessel Occlusion During On- Versus Off-Hours in China The ANGEL-ACT Registry

“…Similar to previous multicenter studies 16,[24][25][26][27] , this study did not reveal a difference in the prognosis or rate of complications between the two groups. Benali et al observed a significantly higher rate of good functional outcomes among inpatients admitted at night (51% vs. 35%, P = 0.05) 28 , but another study found a higher mortality rate among patients admitted at night for EVT 29 , which may be due to the heterogeneity of the stroke center process and sample size.…”

Workflow Intervals and Outcomes of Endovascular Treatment for Acute Large-Vessel Occlusion During On-Vs. Off-hours in China: The ANGEL-ACT Registry

“…Similar to previous multicenter studies (16,(24)(25)(26)(27), this study did not reveal a difference in the prognosis or rate of complications between the two groups. Benali et al observed a significantly increased rate of good functional outcomes among inpatients admitted at night (51 vs. 35%, P = 0.05) (28), but another study found a higher mortality rate among patients admitted at night for EVT (29), which may be due to heterogeneity in stroke center processes and sample sizes.…”

Decrease in intravenous thrombolysis and poor short-term functional prognosis for acute ischemic stroke during the COVID-19 pandemic

“…One of the reasons might be the variation of DNT. One study in the Netherlands showed that early care helped reduce DNT time and decreased patients' NIHSS scores [ 17 ], and another study in the Netherlands showed that overwork affected DNT time [ 18 ]. Given that there was no difference in the time between onset and admission of patients in this study, the effect of DNT on outcomes may have been magnified, leading to worse outcomes in 2020 than in 2019.…”