Early admission to stroke unit influences clinical outcome

Abstract

An improvement in patient arrival time to stroke unit (SU) is recommended, since earlier stroke management seems to improve 'per se' functional outcome. The objective of this study was to determine if early admission influences the outcome, reduces disability and mortality at discharge and three months later independent of tlirombolytic treatment. Consecutive acute stroke patients admitted to SU between January 1st 2000 and December 31st 2003 were studied in order to analyze the actual role of acute management independent specific pharmacological treatment, we excluded subjects who underwent rt-PA. 35.8% of 2,041 consecutive stroke patients arrived within 3 hours; 62.4% within 6 hours; 37.6% arrived later. Approximately 80% of the <6 hour patients presented a National Institutes of Health Stroke Scale (NIHSS) >4 and modified Rankin Scale (mRS) score >2 in comparison with 60% of the >6 hour patients. In hospital (8.7%) and three-month (7.3%) mortality in <3 hour patients were not significantly different from what observed in >3 hour patients (6.8% and 6.1% respectively) while functional outcome after three months was better in <3 hour patients (NIHSS: 34.6 vs 15.2; mRS: 32.9% vs 16.8%). Old age, history of TIA, cardioembolic etiology, severity of neurological deficit and hemorrhagic stroke type all led to earlier arrival time. Admission within 3 hours 'per se' improves outcome and reduced disability at three months.

Early Hospital Arrival Improves Outcome at Discharge in Ischemic but Not Hemorrhagic Stroke: A Prospective Multicenter Study

“…Ischemic stroke patients with severer initial disability have a tendency to visit hospitals earlier [5,6,7,8,9,10,11,12], and severe initial disability is a known predictor of a poor chronic outcome [17,18,19,20,21]. Thus, patients with earlier hospital arrival were reported to have a poorer outcome [5, 6], as was shown in the present unadjusted results.…”

“…However, previous studies have generally shown that patients who arrived at a hospital early after ischemic stroke onset had a worse functional outcome and higher mortality than those who arrived later [5, 6]. Major causes of this discouraging result might be that stroke patients with severer initial disability have a tendency to visit a hospital earlier [5,6,7,8,9,10,11,12], as well as the fact that previous studies did not adjust patient outcome for initial neurological severity. Although intracerebral hemorrhage (ICH) is associated with a poorer outcome than ischemic stroke, the positive relationship between early hospital visit and initial severity was reported only in studies based on relatively small numbers of patients [13, 14].…”

Patients’ and Bystanders’ Awareness of Stroke and Pre-Hospital Delay after Stroke Onset: Perspectives for Thrombolysis in West Pomerania Province, Poland

“…In Western European countries about 30–40% of patients arrived at hospital within 3 h of stroke onset [20, 21]. Considering groups I and II, our results suggest a similar percentage of patients hospitalized within the 3-hour time frame.…”

Association of Hospital Arrival Time with Modified Rankin Scale at Discharge in Patients with Acute Cerebral Infarction

“…Acute ischemic stroke should be considered to be an emergency condition, and the outcome and prognosis is influenced by an early hospital arrival [1,2]. Early stroke treatment has become an important issue after the study finding that an intravenous injection of tissue-type plasminogen activator (t-PA) is effective in patients with all types of acute ischemic stroke when administered within 3 h after the onset of symptoms [3].…”