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

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-or...

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Autores principales: Groot, A. E., de Bruin, H., Nguyen, T. T. M., Kappelhof, M., de Beer, F., Visser, M. C., Zwetsloot, C. P., Halkes, P. H. A., de Kruijk, J., van der Meulen, W. D. M., van der Ree, T. C., Kwa, V. I. H., van Schaik, S. M., Hani, L., van den Berg, R., Sprengers, M. E. S., Roosendaal, S. D., Emmer, B. J., Nederkoorn, P. J., Majoie, C. B. L. M., Roos, Y. B. W. E. M., Coutinho, J. M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815598/
https://www.ncbi.nlm.nih.gov/pubmed/32737653
http://dx.doi.org/10.1007/s00415-020-10106-z
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author Groot, A. E.
de Bruin, H.
Nguyen, T. T. M.
Kappelhof, M.
de Beer, F.
Visser, M. C.
Zwetsloot, C. P.
Halkes, P. H. A.
de Kruijk, J.
van der Meulen, W. D. M.
van der Ree, T. C.
Kwa, V. I. H.
van Schaik, S. M.
Hani, L.
van den Berg, R.
Sprengers, M. E. S.
Roosendaal, S. D.
Emmer, B. J.
Nederkoorn, P. J.
Majoie, C. B. L. M.
Roos, Y. B. W. E. M.
Coutinho, J. M.
author_facet Groot, A. E.
de Bruin, H.
Nguyen, T. T. M.
Kappelhof, M.
de Beer, F.
Visser, M. C.
Zwetsloot, C. P.
Halkes, P. H. A.
de Kruijk, J.
van der Meulen, W. D. M.
van der Ree, T. C.
Kwa, V. I. H.
van Schaik, S. M.
Hani, L.
van den Berg, R.
Sprengers, M. E. S.
Roosendaal, S. D.
Emmer, B. J.
Nederkoorn, P. J.
Majoie, C. B. L. M.
Roos, Y. B. W. E. M.
Coutinho, J. M.
author_sort Groot, A. E.
collection PubMed
description 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00415-020-10106-z) contains supplementary material, which is available to authorized users.
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spelling pubmed-78155982021-01-25 Presentation outside office hours does not negatively influence treatment times for reperfusion therapy for acute ischemic stroke Groot, A. E. de Bruin, H. Nguyen, T. T. M. Kappelhof, M. de Beer, F. Visser, M. C. Zwetsloot, C. P. Halkes, P. H. A. de Kruijk, J. van der Meulen, W. D. M. van der Ree, T. C. Kwa, V. I. H. van Schaik, S. M. Hani, L. van den Berg, R. Sprengers, M. E. S. Roosendaal, S. D. Emmer, B. J. Nederkoorn, P. J. Majoie, C. B. L. M. Roos, Y. B. W. E. M. Coutinho, J. M. J Neurol Original Communication 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00415-020-10106-z) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2020-07-31 2021 /pmc/articles/PMC7815598/ /pubmed/32737653 http://dx.doi.org/10.1007/s00415-020-10106-z Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Original Communication
Groot, A. E.
de Bruin, H.
Nguyen, T. T. M.
Kappelhof, M.
de Beer, F.
Visser, M. C.
Zwetsloot, C. P.
Halkes, P. H. A.
de Kruijk, J.
van der Meulen, W. D. M.
van der Ree, T. C.
Kwa, V. I. H.
van Schaik, S. M.
Hani, L.
van den Berg, R.
Sprengers, M. E. S.
Roosendaal, S. D.
Emmer, B. J.
Nederkoorn, P. J.
Majoie, C. B. L. M.
Roos, Y. B. W. E. M.
Coutinho, J. M.
Presentation outside office hours does not negatively influence treatment times for reperfusion therapy for acute ischemic stroke
title Presentation outside office hours does not negatively influence treatment times for reperfusion therapy for acute ischemic stroke
title_full Presentation outside office hours does not negatively influence treatment times for reperfusion therapy for acute ischemic stroke
title_fullStr Presentation outside office hours does not negatively influence treatment times for reperfusion therapy for acute ischemic stroke
title_full_unstemmed Presentation outside office hours does not negatively influence treatment times for reperfusion therapy for acute ischemic stroke
title_short Presentation outside office hours does not negatively influence treatment times for reperfusion therapy for acute ischemic stroke
title_sort presentation outside office hours does not negatively influence treatment times for reperfusion therapy for acute ischemic stroke
topic Original Communication
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815598/
https://www.ncbi.nlm.nih.gov/pubmed/32737653
http://dx.doi.org/10.1007/s00415-020-10106-z
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