Early arrival did not ensure the early acquisition of intravenous thrombosis for acute ischemic stroke during the COVID‐19 pandemic

BACKGROUND: Intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) is a time‐dependent treatment with a narrow therapeutic time window, in which the time delay could result from the deadline effect. METHODS: One hospital‐based cohort was recruited to detect the factors contributing to the dea...

Descripción completa

Detalles Bibliográficos
Autores principales: Qiang, Huang, Jin‐mei, Sun, Yan‐fei, Han, Yong‐bo, Zhang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10175972/
https://www.ncbi.nlm.nih.gov/pubmed/36974385
http://dx.doi.org/10.1002/brb3.2977
_version_ 1785040332551880704
author Qiang, Huang
Jin‐mei, Sun
Yan‐fei, Han
Yong‐bo, Zhang
author_facet Qiang, Huang
Jin‐mei, Sun
Yan‐fei, Han
Yong‐bo, Zhang
author_sort Qiang, Huang
collection PubMed
description BACKGROUND: Intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) is a time‐dependent treatment with a narrow therapeutic time window, in which the time delay could result from the deadline effect. METHODS: One hospital‐based cohort was recruited to detect the factors contributing to the deadline effect, where patients with the deadline effect were defined as those who were presented with the onset‐to‐door time (ODT) in the first 50%, while the door‐to‐needle time (DNT) was in the last quartile. DNT (in‐hospital delay) was further subdivided into several time intervals [door‐to‐examination time (DET), door‐to‐imaging time (DIT), door‐to‐laboratory time (DLT), and decision‐making time (DMT) of the patients or their proxies. RESULTS: A total of 186 IVT cases were enrolled, of which 17.2% (32/186) suffered a delay of the deadline effect. The median age was 66 years, and 35.5% were female. Baseline characteristics were similar between the two groups (all p > .05). For the comparisons of the time intervals, DIT (26 versus 15 min, p = .001) was significantly longer in the group with deadline effect, while the differences of DET, DLT, DMT, and ONT did not reach statistical significance (all p > .05). Upon multivariable adjustment in the binary logistic regression model, longer DIT [odds ratio (OR), 1.076; 95% confidence interval (CI), 1.036–1.118; p < .001], and history of coronary heart disease (OR, 3.898; 95%CI, 1.415–10.735; p = .008) were independently associated with deadline effect in the binary logistic regression model, while admitted in the working day (OR, 0.674; 95%CI, 0.096–0.907; p = .033), and having medical insurance (OR, 0.350; 95% CI, 0.132–0.931; p = .035) were negatively associated with the deadline effect. CONCLUSIONS: A speed‐safety tradeoff phenomenon from the deadline effect was observed in 17.2% of IVT cases during the COVID‐19 pandemic, where longer DIT contributed a lot to this time delay. Patients without medical insurance, or admitted in official holidays were more likely to experience a delay of the deadline effect.
format Online
Article
Text
id pubmed-10175972
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-101759722023-05-13 Early arrival did not ensure the early acquisition of intravenous thrombosis for acute ischemic stroke during the COVID‐19 pandemic Qiang, Huang Jin‐mei, Sun Yan‐fei, Han Yong‐bo, Zhang Brain Behav Original Articles BACKGROUND: Intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) is a time‐dependent treatment with a narrow therapeutic time window, in which the time delay could result from the deadline effect. METHODS: One hospital‐based cohort was recruited to detect the factors contributing to the deadline effect, where patients with the deadline effect were defined as those who were presented with the onset‐to‐door time (ODT) in the first 50%, while the door‐to‐needle time (DNT) was in the last quartile. DNT (in‐hospital delay) was further subdivided into several time intervals [door‐to‐examination time (DET), door‐to‐imaging time (DIT), door‐to‐laboratory time (DLT), and decision‐making time (DMT) of the patients or their proxies. RESULTS: A total of 186 IVT cases were enrolled, of which 17.2% (32/186) suffered a delay of the deadline effect. The median age was 66 years, and 35.5% were female. Baseline characteristics were similar between the two groups (all p > .05). For the comparisons of the time intervals, DIT (26 versus 15 min, p = .001) was significantly longer in the group with deadline effect, while the differences of DET, DLT, DMT, and ONT did not reach statistical significance (all p > .05). Upon multivariable adjustment in the binary logistic regression model, longer DIT [odds ratio (OR), 1.076; 95% confidence interval (CI), 1.036–1.118; p < .001], and history of coronary heart disease (OR, 3.898; 95%CI, 1.415–10.735; p = .008) were independently associated with deadline effect in the binary logistic regression model, while admitted in the working day (OR, 0.674; 95%CI, 0.096–0.907; p = .033), and having medical insurance (OR, 0.350; 95% CI, 0.132–0.931; p = .035) were negatively associated with the deadline effect. CONCLUSIONS: A speed‐safety tradeoff phenomenon from the deadline effect was observed in 17.2% of IVT cases during the COVID‐19 pandemic, where longer DIT contributed a lot to this time delay. Patients without medical insurance, or admitted in official holidays were more likely to experience a delay of the deadline effect. John Wiley and Sons Inc. 2023-03-27 /pmc/articles/PMC10175972/ /pubmed/36974385 http://dx.doi.org/10.1002/brb3.2977 Text en © 2023 The Authors. Brain and Behavior published by Wiley Periodicals LLC. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Qiang, Huang
Jin‐mei, Sun
Yan‐fei, Han
Yong‐bo, Zhang
Early arrival did not ensure the early acquisition of intravenous thrombosis for acute ischemic stroke during the COVID‐19 pandemic
title Early arrival did not ensure the early acquisition of intravenous thrombosis for acute ischemic stroke during the COVID‐19 pandemic
title_full Early arrival did not ensure the early acquisition of intravenous thrombosis for acute ischemic stroke during the COVID‐19 pandemic
title_fullStr Early arrival did not ensure the early acquisition of intravenous thrombosis for acute ischemic stroke during the COVID‐19 pandemic
title_full_unstemmed Early arrival did not ensure the early acquisition of intravenous thrombosis for acute ischemic stroke during the COVID‐19 pandemic
title_short Early arrival did not ensure the early acquisition of intravenous thrombosis for acute ischemic stroke during the COVID‐19 pandemic
title_sort early arrival did not ensure the early acquisition of intravenous thrombosis for acute ischemic stroke during the covid‐19 pandemic
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10175972/
https://www.ncbi.nlm.nih.gov/pubmed/36974385
http://dx.doi.org/10.1002/brb3.2977
work_keys_str_mv AT qianghuang earlyarrivaldidnotensuretheearlyacquisitionofintravenousthrombosisforacuteischemicstrokeduringthecovid19pandemic
AT jinmeisun earlyarrivaldidnotensuretheearlyacquisitionofintravenousthrombosisforacuteischemicstrokeduringthecovid19pandemic
AT yanfeihan earlyarrivaldidnotensuretheearlyacquisitionofintravenousthrombosisforacuteischemicstrokeduringthecovid19pandemic
AT yongbozhang earlyarrivaldidnotensuretheearlyacquisitionofintravenousthrombosisforacuteischemicstrokeduringthecovid19pandemic