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May 16, 2019

ESOC-2019

PRESENTATION OUTSIDE OFFICE HOURS DOES NOT INFLUENCE TREATMENT TIMES FOR REPERFUSION THERAPY FOR ACUTE ISCHEMIC STROKE IN THE GREATER AMSTERDAM AREA

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acute ischemic stroke

outside office hours

in-hospital logistics

time-to-treatment

reperfusion therapy

Abstract

Abstract

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Keywords

acute ischemic stroke

outside office hours

in-hospital logistics

time-to-treatment

reperfusion therapy

Abstract

Background: Presentation outside office hours has been associated with increased treatment times for intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS). Limited data suggest that such “off-hours effect” also exists for endovascular treatment (EVT). We investigated the presence of an off-hours effect 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 (IVT or EVT) in the ‘Greater Amsterdam Area’ (IVT: 2009-2015, EVT: 2014-2016). Office hours were defined as presentation during weekdays (excluding National Festive days) between 8AM-5PM. 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 of the first hospital. Secondary outcomes included in-hospital mortality and symptomatic intracranial hemorrhage (sICH). We performed multivariable linear and logistic regression analysis and used multiple imputation to account for missing values. Results: Respectively 59% (2450/4161) and 61% (239/395) of patients treated with IVT and EVT presented outside office hours. Median DNT was slightly longer outside office hours (32 vs. 30 minutes, aß 2.4, 95% CI 0.6-4.1). Presentation outside office hours was not associated with a longer DGT (median 130 minutes for both groups, aß 5.1, 95% CI -7.8-18.1). There was also no difference in DGT for transferred patients (aß 4.5, 95% CI -9.4-18.4) or directly presented patients (aß 7.7, 95% CI -14.3-29.7). sICH rate and in-hospital mortality also did not differ. Conclusion: Presentation outside office hours did not lead to longer treatment times for reperfusion therapy in patients with AIS.

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© Copyright 2019 Morressier GmbH.
All rights reserved.