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Is there a bad time for intravenous thrombolysis? The experience of Polish stroke centers
Affiliations- 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
- Interventional Stroke Treatment Centre, Institute of Psychiatry and Neurology, Warsaw, Poland
- Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland
- Department of Neurology, University Hospital no. 2, Bydgoszcz, Poland
- Department of Neurology A, Provincial Specialistic Team Neuropsychiatric, Opole, Poland
- Department of Neurology, Pomeranian Trauma Centre, Gdańsk, Poland
- Department of Neurology, Medical University of Gdansk, Poland
- Department of Neurology, Voivodship Hospital no. 2, Rzeszów, Poland
- Department of Neurology, Central Clinical Hospital of the Ministry of the Interior, Warsaw, Poland
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Abstract
The outcome in acute stroke strongly depends on patient-related issues, as well as on the availability of human and diagnostic resources. Our aim was to evaluate safety and effectiveness of intravenous alteplase for stroke according to the time of admission to the hospital.
Materials and methodsWe analyzed the data of all acute stroke patients treated with alteplase between October 2003 and December 2010, contributed to the Safe Implementation of Thrombolysis for Stroke registry from 27 Polish stroke centers. According to the time of admission we distinguished between: (1) non-working days (Friday 14:30–Monday 08:00 plus national holidays); (2) out-of-office hours (non-working days plus 14:30–08:00 during working days); and (3) night hours (time from 23:00 to 06:00). Patients admitted during regular working hours (Monday 08:00–Friday 14:30, excluding national holidays) were used as the reference.
ResultsOf 1330 patients, 448 (32.5%) were admitted on non-working days, 868 (65.3%) at out-of-office hours, and 105 (7.9%) during night hours. In multivariate logistic regression, none of the evaluated periods showed association with symptomatic intracranial hemorrhage, 7-day mortality, and neurological improvement ≥4 points in the National Institutes of Health Stroke Scale score at day 7. Patients admitted during night hours had lower odds (OR 0.53, 95% CI: 0.29–0.95, p=0.032) for achieving favorable outcome (modified Rankin Scale score 0–2).
ConclusionsThere is no bad time for thrombolysis. Stroke centers should feel confident about the treatment outside regular working hours, irrespective of equipment and staff availability. However, it may be reasonable to pay additional attention during nighttime.
Abstract
The outcome in acute stroke strongly depends on patient-related issues, as well as on the availability of human and diagnostic resources. Our aim was to evaluate safety and effectiveness of intravenous alteplase for stroke according to the time of admission to the hospital.
Materials and methodsWe analyzed the data of all acute stroke patients treated with alteplase between October 2003 and December 2010, contributed to the Safe Implementation of Thrombolysis for Stroke registry from 27 Polish stroke centers. According to the time of admission we distinguished between: (1) non-working days (Friday 14:30–Monday 08:00 plus national holidays); (2) out-of-office hours (non-working days plus 14:30–08:00 during working days); and (3) night hours (time from 23:00 to 06:00). Patients admitted during regular working hours (Monday 08:00–Friday 14:30, excluding national holidays) were used as the reference.
ResultsOf 1330 patients, 448 (32.5%) were admitted on non-working days, 868 (65.3%) at out-of-office hours, and 105 (7.9%) during night hours. In multivariate logistic regression, none of the evaluated periods showed association with symptomatic intracranial hemorrhage, 7-day mortality, and neurological improvement ≥4 points in the National Institutes of Health Stroke Scale score at day 7. Patients admitted during night hours had lower odds (OR 0.53, 95% CI: 0.29–0.95, p=0.032) for achieving favorable outcome (modified Rankin Scale score 0–2).
ConclusionsThere is no bad time for thrombolysis. Stroke centers should feel confident about the treatment outside regular working hours, irrespective of equipment and staff availability. However, it may be reasonable to pay additional attention during nighttime.
Keywords
Ischemic stroke, Thrombolysis, Alteplase, Time of admission, Weekends, Outcome
About this articleTitle
Is there a bad time for intravenous thrombolysis? The experience of Polish stroke centers
Journal
Neurologia i Neurochirurgia Polska
Issue
Pages
45-51
Page views
351
Article views/downloads
546
DOI
10.1016/j.pjnns.2013.12.003
Bibliographic record
Neurol Neurochir Pol 2014;48(1):45-51.
Keywords
Ischemic stroke
Thrombolysis
Alteplase
Time of admission
Weekends
Outcome
Authors
Michał Karliński
Adam Kobayashi
Piotr Sobolewski
Paweł Lisewski
Sławomir Romanowicz
Waldemar Fryze
Walenty Nyka
Marcin Zięba
Małgorzata Dorobek
Anna Członkowska
