Effect of admission time on provision of acute stroke treatment at stroke units and stroke centers-An analysis of the Swiss Stroke Registry.

Altersberger, Valerian L; Wright, Patrick R; Schaedelin, Sabine A; De Marchis, Gian Marco; Gensicke, Henrik; Engelter, Stefan T; Psychogios, Marios; Kahles, Timo; Goeldlin, Martina; Meinel, Thomas R; Mordasini, Pasquale; Kaesmacher, Johannes; von Hessling, Alexander; Vehoff, Jochen; Weber, Johannes; Wegener, Susanne; Salmen, Stephan; Sturzenegger, Rolf; Medlin, Friedrich; Berger, Christian; ... (2022). Effect of admission time on provision of acute stroke treatment at stroke units and stroke centers-An analysis of the Swiss Stroke Registry. European stroke journal, 7(2), pp. 117-125. Sage 10.1177/23969873221094408

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Introduction

Rapid treatment of acute ischemic stroke (AIS) depends on sufficient staffing which differs between Stroke Centers and Stroke Units in Switzerland. We studied the effect of admission time on performance measures of AIS treatment and related temporal trends over time.

Patients and methods

We compared treatment rates, door-to-image-time, door-to-needle-time, and door-to-groin-puncture-time in stroke patients admitted during office hours (Monday-Friday 8:00-17:59) and non-office hours at all certified Stroke Centers and Stroke Units in Switzerland, as well as secular trends thereof between 2014 and 2019, using data from the Swiss Stroke Registry. Secondary outcomes were modified Rankin Scale and mortality at 3 months.

Results

Data were eligible for analysis in 31,788 (90.2%) of 35,261 patients. Treatment rates for IVT/EVT were higher during non-office hours compared with office hours in Stroke Centers (40.8 vs 36.5%) and Stroke Units (21.8 vs 18.5%). Door-to-image-time and door-to-needle-time increased significantly during non-office hours. Median (IQR) door-to-groin-puncture-time at Stroke Centers was longer during non-office hours compared to office hours (84 (59-116) vs 95 (66-130) minutes). Admission during non-office hours was independently associated with worse functional outcome (1.11 [95%CI: 1.04-1.18]) and increased mortality (1.13 [95%CI: 1.01-1.27]). From 2014 to 2019, median door-to-groin-puncture-time improved and the treatment rate for wake-up strokes increased.

Discussion and Conclusion

Despite differences in staffing, patient admission during non-office hours delayed IVT to a similar, modest degree at Stroke Centers and Stroke Units. A larger delay of EVT was observed during non-office hours, but Stroke Centers sped up delivery of EVT over time. Patients admitted during non-office hours had worse functional outcomes, which was not explained by treatment delays.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Göldlin, Martina Béatrice, Meinel, Thomas Raphael, Mordasini, Pasquale Ranato, Kaesmacher, Johannes, Arnold, Marcel, Fischer, Urs Martin

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2396-9873

Publisher:

Sage

Language:

English

Submitter:

Pubmed Import

Date Deposited:

02 Jun 2022 13:42

Last Modified:

02 Mar 2023 23:36

Publisher DOI:

10.1177/23969873221094408

PubMed ID:

35647311

Uncontrolled Keywords:

Stroke admission time outcome quality of care service provision

BORIS DOI:

10.48350/170399

URI:

https://boris.unibe.ch/id/eprint/170399

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