Non-office-hours admission affects intravenous thrombolysis treatment times and clinical outcome

Zonneveld, Thomas P.; Curtze, Sami; Zinkstok, Sanne M.; Gensicke, Henrik; Moulin, Solène; Scheitz, Jan F.; Seiffge, David J; Hametner, Christian; Heldner, Mirjam Rachel; Traenka, Christopher; Erdur, Hebun; Baharoglu, Irem; Martinez‐Majander, Nicolas; Pezzini, Alessandro; Zini, Andrea; Padjen, Višnja; Correia, Pamela; Strbian, Daniel; Michel, Patrik; Béjot, Yannick; Arnold, Marcel; Leys, Didier; Ringleb, Peter A.; Tatlısumak, Turgut; Nolte, Christian H.; Engelter, Stefan T.; Nederkoorn, Paul J.

doi:10.1136/jnnp-2017-316791

Cited by 6 publications

(6 citation statements)

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“…A number of studies previously evaluated a possible "off hours" effect in patients receiving IVT [7,[14][15][16]. The results of our study are generally in line with the results from a large European, multicenter cohort (TRISP), which also found a 2 min increase in DNT for presentation outside office hours.…”

Section: Discussionsupporting

confidence: 89%

“…The results of our study are generally in line with the results from a large European, multicenter cohort (TRISP), which also found a 2 min increase in DNT for presentation outside office hours. Though the increased DNT observed in TRISP was statistically significant, this study also found no association with clinical outcome, providing further proof that these small DNT differences are unlikely to be clinically relevant [7]. While various studies have examined the off-hours effect for IVT, data on this topic for EVT are scarce.…”

Section: Discussionmentioning

confidence: 47%

“…Stroke patients often present outside of office hours, which may cause treatment delay, for example due to lower staff attendance, and decreased availability of imaging [3]. Previous studies on the existence of such an "offhours effect" have yielded conflicting results, observing both longer and shorter treatment times for patients presenting outside office hours [4][5][6][7]. Moreover, these studies mostly focused on door-to-needle times (DNT) for IVT, and there are limited data available on door-to-groin times (DGT) for EVT [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Presentation outside office hours does not negatively influence treatment times for reperfusion therapy for acute ischemic stroke

et al. 2020

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Background Treatment outside office hours has been associated with increased workflow times for intravenous thrombolysis (IVT) in acute ischemic stroke (AIS). Limited data suggest that this "off-hours effect" also exists for endovascular treatment (EVT). We investigated this phenomenon 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 in the Greater Amsterdam Area, consisting of 14 primary stroke centers and 1 comprehensive stroke center (IVT: 2009-2015, EVT: 2014-2017). Office hours were defined as presentation during weekdays between 8 AM and 5 PM, excluding National Festive days. 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 time of the first hospital. Other outcomes were in-hospital mortality, modified Rankin Scale (mRS) score at 90 days and symptomatic intracranial hemorrhage (sICH). We performed multivariable linear and logistic regression analyses and used multiple imputation to account for missing values. Results In total, 59% (2450/4161) and 61% (239/395) of patients treated with IVT and EVT, respectively, presented outside office hours. Median DNT was minimally longer outside office hours (32 vs. 30 min, p = 0.024, adjusted difference 2.5 min, 95% CI 0.7-4.2). Presentation outside office hours was not associated with a longer DGT (median 130 min for both groups, adjusted difference 7.0 min, 95% CI − 4.2 to 18.1). Clinical outcome and sICH rate also did not differ. Conclusion Presentation outside office hours did not lead to clinically relevant treatment delays for reperfusion therapy in patients with AIS.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 47%

Section: Introductionmentioning

confidence: 99%

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Presentation outside office hours does not negatively influence treatment times for reperfusion therapy for acute ischemic stroke

et al. 2020

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“…More research has to be done to explain this sex disparity. Admission during off-hours is likely a delaying factor for IVT, implying that the acute stroke service is not as prompt during off-hours, similar to which was found in several earlier studies [8, 21]. This may be due to reduced staff or the limited availability of resources.…”

Section: Discussionmentioning

confidence: 58%

Determinants of extended door-to-needle time in acute ischemic stroke and its influence on in-hospital mortality: results of a nationwide Dutch clinical audit

et al. 2019

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BackgroundIntravenous thrombolysis (IVT) plays a prominent role in the treatment of acute ischemic stroke (AIS). The sooner IVT is administered, the higher the odds of a good outcome. Therefore, registering the in-hospital time to treatment with IVT, i.e. the door-to-needle time (DNT), is a powerful way to measure quality improvement. The aim of this study was to identify determinants that are associated with extended DNT.MethodsPatients receiving IVT in 2015 and 2016 registered in the Dutch Acute Stroke Audit were included. DNT and onset-to-door time (ODT) were dichotomized using the median (i.e. extended DNT) and the 90th percentile (i.e. severely extended DNT). Logistic regression was performed to identify determinants associated with (severely) extended DNT/ODT and its effect on in-hospital mortality. A linear model with natural spline was used to investigate the association between ODT and DNT.ResultsIncluded were 9518 IVT treated patients from 75 hospitals. Median DNT was 26 min (IQR 20–37). Determinants associated with a higher likelihood of extended DNT were female sex (OR 1.17, 95% CI 1.05–1.31) and admission during off-hours (OR 1.12, 95% CI 1.01–1.25). Short ODT correlated with longer DNT, whereas longer ODT correlated with shorter DNT. Young age (OR 1.38, 95% CI 1.07–1.76) and admission to a comprehensive stroke center (OR 1.26, 1.10–1.45) were associated with severely extended DNT, which was associated with in-hospital mortality (OR 1.54, 95%CI 1.19–1.98).ConclusionsEven though DNT in the Netherlands is short compared to other countries, lowering the DNT may be achievable by focusing on specific subgroups.

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“…35 Using the TRISP registry, we previously examined the safety of IVT in a number of patient subgroups where RCT-based data did not exist. Previous publications of the TRISP registry: (1) provided insight into safety and efficacy of IVT in subgroups of patients who were excluded in RCTs (eg, patients dependent on the help of others prior to stroke), under-represented or not specifically addressed (eg, dissection as cause, impaired renal function, low platelet count, body mass index, prior use of statins, serotonin uptake inhibitors, prior use of novel oral anticoagulants and patients with seizure at onset) 21 36-45 ; (2) facilitated the evaluation process of acute stroke care such as the meaning of the 'off-hourthrombolysis', IVT during 'working hours' or the variable 'time' in clinical practice [46][47][48] ; and (3) served to derive, validate and compare risk scores for sICH or functional 3 months outcome. [49][50][51] These registry-based novel data contributed to the numbers of patients treated safely and successfully with IVT globally.…”

Section: Open Accessmentioning

confidence: 99%

EndoVAscular treatment and ThRombolysis for Ischemic Stroke Patients (EVA-TRISP) registry: basis and methodology of a pan-European prospective ischaemic stroke revascularisation treatment registry

et al. 2021

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PurposeThe Thrombolysis in Ischemic Stroke Patients (TRISP) collaboration was a concerted effort initiated in 2010 with the purpose to address relevant research questions about the effectiveness and safety of intravenous thrombolysis (IVT). The collaboration also aims to prospectively collect data on patients undergoing endovascular treatment (EVT) and hence the name of the collaboration was changed from TRISP to EVA-TRISP. The methodology of the former TRISP registry for patients treated with IVT has already been published. This paper focuses on describing the EVT part of the registry.ParticipantsAll centres committed to collecting predefined variables on consecutive patients prospectively. We aim for accuracy and completeness of the data and to adapt local databases to investigate novel research questions. Herein, we introduce the methodology of a recently constructed academic investigator-initiated open collaboration EVT registry built as an extension of an existing IVT registry in patients with acute ischaemic stroke (AIS).Findings to dateCurrently, the EVA-TRISP network includes 20 stroke centres with considerable expertise in EVT and maintenance of high-quality hospital-based registries. Following several successful randomised controlled trials (RCTs), many important clinical questions remain unanswered in the (EVT) field and some of them will unlikely be investigated in future RCTs. Prospective registries with high-quality data on EVT-treated patients may help answering some of these unanswered issues, especially on safety and efficacy of EVT in specific patient subgroups.Future plansThis collaborative effort aims at addressing clinically important questions on safety and efficacy of EVT in conditions not covered by RCTs. The TRISP registry generated substantial novel data supporting stroke physicians in their daily decision making considering IVT candidate patients. While providing observational data on EVT in daily clinical practice, our future findings may likewise be hypothesis generating for future research as well as for quality improvement (on EVT). The collaboration welcomes participation of further centres willing to fulfill the commitment and the outlined requirements.

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Non-office-hours admission affects intravenous thrombolysis treatment times and clinical outcome

Cited by 6 publications

References 4 publications

Presentation outside office hours does not negatively influence treatment times for reperfusion therapy for acute ischemic stroke

Presentation outside office hours does not negatively influence treatment times for reperfusion therapy for acute ischemic stroke

Determinants of extended door-to-needle time in acute ischemic stroke and its influence on in-hospital mortality: results of a nationwide Dutch clinical audit

EndoVAscular treatment and ThRombolysis for Ischemic Stroke Patients (EVA-TRISP) registry: basis and methodology of a pan-European prospective ischaemic stroke revascularisation treatment registry

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