Direct access to a hospital offering intravenous thrombolysis therapy improves functional outcome of acute ischemic stroke patients.

Referral from other hospitals is one of the primary causes of delayed thrombolysis therapy after acute ischemic stroke (AIS). We aimed to evaluate whether direct access to a hospital offering intravenous thrombolysis therapy was associated with good functional outcome in AIS patients treated with thrombolysis. We enrolled patients who received intravenous thrombolysis within 3 hours of symptom onset at our stroke center. We divided these patients into two groups: those with a direct admission to our stroke center and those with indirect admission by referral from other community hospitals. We investigated onset-to-door time and onset-to-recombinant tissue plasminogen activator (rtPA) time according to admission mode. We then assessed the association between a direct admission and favorable outcome at 90 days. A total of 232 patients (mean age of 66.6 years, median National Institutes of Health Stroke Scale score of 10) were included. A total of 48.7% of AIS patients treated with intravenous thrombolytic therapy were transferred from other hospitals. Patients who were directly admitted to our stroke center had a shorter onset-to-door time (61 versus 120 minutes, p<0.001) and onset-to-rtPA time (103 versus 155 minutes, p<0.001) than those referred from other hospitals. Direct admission was associated with a good outcome with an odds ratio of 2.03 (95% confidence interval 1.051-3.917, p=0.035), after adjusting for baseline variables. Thrombolysis after direct admission to a hospital offering intravenous thrombolysis therapy could shorten onset-to-rtPA time and improve stroke outcome in patients with AIS.

Kim DH ，Cha JK ，Park HS ，Choi JH ，Kang MJ ，Huh JT ... -  《-》

Direct admission to stroke centers reduces treatment delay and improves clinical outcome after intravenous thrombolysis.

We aimed to examine whether direct access to hospitals offering intravenous thrombolysis is associated with functional outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis. We enrolled patients who received intravenous thrombolysis within 4.5hours of symptom onset using a prospective multicenter registry database. Patients referred directly from the field to organized stroke centers were compared with those who were transferred from non-thrombolysis-capable hospitals in terms of clinical outcomes at 90days after intravenous recombinant tissue plasminogen activator treatment. We also investigated onset-to-door time and onset-to-needle time according to admission mode. A total of 820 patients (mean age of 67.3years and median National Institutes of Health Stroke Scale score of 9) were enrolled. Seventeen percent of patients with AIS who received intravenous thrombolytic therapy at 12 hospitals (n=142) were transferred from other hospitals. The direct admission group had a shorter median onset-to-admission time (63 versus 121minutes, P<0.001) and onset-to-needle time (110 versus 161minutes, P<0.001) as compared with the indirect admission group. Direct admission was associated with a good outcome with an odds ratio of 1.57 (95% confidence interval: 1.02-2.39, P=0.036) after adjustment for baseline variables. Direct admission to a hospital with intravenous thrombolysis facilities available at all times was associated with shorter onset-to-needle time and better outcome in patients with AIS undergoing thrombolytic therapy. Our findings support the implementation of regional stroke care programs transporting patients directly to stroke centers to promote faster treatment and to achieve better outcomes.

Kim DH ，Bae HJ ，Han MK ，Kim BJ ，Park SS ，Park TH ，Lee KB ，Kang K ，Park JM ，Ko Y ，Lee SJ ，Choi JC ，Kim JT ，Cho KH ，Hong KS ，Cho YJ ，Kim DE ，Lee J ，Lee J ，Oh MS ，Yu KH ，Lee BC ，Nah HW ，Cha JK ... -  《-》

Temporal trends in patient characteristics and treatment with intravenous thrombolysis among acute ischemic stroke patients at Get With The Guidelines-Stroke hospitals.

Schwamm LH ，Ali SF ，Reeves MJ ，Smith EE ，Saver JL ，Messe S ，Bhatt DL ，Grau-Sepulveda MV ，Peterson ED ，Fonarow GC ... -  《-》

Thrombolysis for acute ischemic stroke: do patients treated out of hours have a worse outcome?

Previous studies on the impact of nonworking hours (NWH) have produced conflicting results. We aimed to compare the time to treatment with thrombolysis between NWH and working hours (WH) at an Australian comprehensive stroke center. All acute ischemic stroke patients treated with intravenous alteplase (IV-alteplase) from January 2003 to December 2011 at the Royal Melbourne Hospital were included. Data collected included demographics, serial time points (including onset, presentation to emergency department, neuroimaging, and thrombolysis), and clinical outcomes (modified Rankin Scale [mRS] and death) at 3 months. NWH were defined as weekdays 5 PM-8 AM, weekends, and public holidays. Comparisons were made in the door-to-computed tomography (CT) time, the door-to-needle time, mRS, and mortality within 3 months between the NWH group and WH group. We recruited 388 consecutive patients who received IV-alteplase, 226 patients were in NWH and 162 patients in WH. The median age was 71 years (Interquartile range [IQR] = 60-79), 54.1% of patients were male, and the median National Institutes of Health Stroke Scale score was 13 (IQR = 8-18). No significant differences were observed at baseline between the NWH and WH groups except for prior stroke. There was a 15-minute increase in the median door-to-needle time (80 minutes in the NWH group versus 64.5 minutes in the WH group, 95% confidence interval [CI]: 6.36-23.64, P = .001). No significant differences were noted in the median door-to-CT time (95% CI: -1.16 to 9.16, P = .128) and clinical outcomes at 3 months (P > .05). Both the door-to-CT time and the door-to-needle time became shorter over the period of the study (P < .001). Our study showed that the "NWH effect" increased the door-to-needle time. The patients treated out of hours did not have a worse outcome.

Fang K ，Churilov L ，Weir L ，Dong Q ，Davis S ，Yan B ... -  《-》

Emergency medical service hospital prenotification is associated with improved evaluation and treatment of acute ischemic stroke.

Lin CB ，Peterson ED ，Smith EE ，Saver JL ，Liang L ，Xian Y ，Olson DM ，Shah BR ，Hernandez AF ，Schwamm LH ，Fonarow GC ... -  《Circulation-Cardiovascular Quality and Outcomes》