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

Autor: Groot AE; Neurology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands., de Bruin H; Neurology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands., Nguyen TTM; Neurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands., Kappelhof M; Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands., de Beer F; Neurology, Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC, Haarlem, The Netherlands., Visser MC; Neurology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Boelelaan 1117-1118, 1081 HV, Amsterdam, The Netherlands., Zwetsloot CP; Neurology, Dijklander, Waterlandlaan 250, 1441 RN, Purmerend, The Netherlands., Halkes PHA; Neurology, Noord-West Ziekenhuisgroep, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands., de Kruijk J; Neurology, Tergooi, Van Linschotenlaan 35, 1212 DR, Hilversum, The Netherlands., van der Meulen WDM; Neurology, Rode Kruis, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands., van der Ree TC; Neurology, Dijklander, Maelsonstraat 3, 1624 NP, Hoorn, The Netherlands., Kwa VIH; Neurology, OLVG-Oost, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands., van Schaik SM; Neurology, OLVG-West, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands., Hani L; Neurology, Noord-West Ziekenhuisgroep, Huisduinerweg 3, 1782 GZ, Den Helder, The Netherlands., van den Berg R; Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands., Sprengers MES; Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands., Roosendaal SD; Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands., Emmer BJ; Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands., Nederkoorn PJ; Neurology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands., Majoie CBLM; Radiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands., Roos YBWEM; Neurology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands., Coutinho JM; Neurology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. j.coutinho@amsterdamumc.nl.
Jazyk: angličtina
Zdroj: Journal of neurology [J Neurol] 2021 Jan; Vol. 268 (1), pp. 133-139. Date of Electronic Publication: 2020 Jul 31.
DOI: 10.1007/s00415-020-10106-z
Abstrakt: 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.
Databáze: MEDLINE
Externí odkaz: