Weekend effect in endovascular stroke treatment: do treatment decisions, procedural times, and outcome depend on time of admission?

Nikoubashman, Omid; Probst, Thomas; Schürmann, Kolja; Othman, Ahmed E.; Matz, Oliver; Brockmann, Marc-Alexander; Müller, Markus; Wiesmann, Martin; Reich, Arno

doi:10.1136/neurintsurg-2015-012220

Cited by 16 publications

(15 citation statements)

References 19 publications

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“…This is consistent with a previous study that suggested the absence of a weekend effect on stroke procedural times 16. However, the present study did suggest a delay of approximately 50 min from notification to puncture during non-work hours compared with work hours.…”

Section: Discussionsupporting

confidence: 93%

A multicenter study evaluating the frequency and time requirement of mechanical thrombectomy

Wilson

Leslie‐Mazwi

Hirsch

et al. 2017

J NeuroIntervent Surg

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Section: Discussionsupporting

confidence: 93%

A multicenter study evaluating the frequency and time requirement of mechanical thrombectomy

Wilson

Leslie‐Mazwi

Hirsch

et al. 2017

J NeuroIntervent Surg

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“…These metrics should be applicable regardless of the time of the day and regardless of whether the patient presents on a weekday versus a weekend. 103 These metrics represent maximum recommended times. Because of ample evidence that, the shorter the time to reperfusion, the higher the likelihood of a favorable outcome, all centers should strive to initiate endovascular therapy within the shortest possible time frame.…”

Section: Time Intervalsmentioning

confidence: 99%

Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke

Sacks

Baxter

Campbell

et al. 2018

AJNR Am J Neuroradiol

193

179

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ABBREVIATIONS: ASPECTS ϭ Alberta Stroke Program Early Computed Tomography Score; EVT ϭ endovascular therapy; mRS ϭ modified Rankin Scale; mTICI ϭ modified thrombolysis in cerebral infarction; NIHSS ϭ National Institutes of Health Stroke Scale; QI ϭ quality improvement; SAH ϭ subarachnoid hemorrhage; SICH ϭ symptomatic intracranial hemorrhage; SITS-MOST ϭ Safe Implementation of Thrombolysis in Stroke Monitoring Study; TICI ϭ thrombolysis in cerebral infarction; TIMI ϭ thrombolysis in myocardial infarction; TPA ϭ tissue plasminogen activator E ndovascular therapy (EVT) for acute ischemic stroke in selected patients has recently been proved effective in several clinical trials, and the widespread adoption of thrombectomy into routine clinical practice has begun. However, these acute stroke services are resource-intensive, including advanced cerebral im-aging and highly trained multidisciplinary hospital teams rapidly responding to emergency activation. Despite the previous acceptance of intravenous fibrinolysis for acute ischemic stroke and the development of designated stroke centers, 1 ischemic stroke remains a leading cause of adult death and disability. 2 Many patients are not candidates for fibrinolysis, and intravenous therapy is relatively ineffective for severe strokes as a result of large cerebral artery occlusions. Moreover, it is uncertain if the benefits of endovascular stroke treatment in the trial setting can be generalized to clinical care provided by hospitals and teams of varying training, experience, and case volume. In other medical disciplines, rapid technologic advancement required guidelines to utilize these tools effectively and responsibly. 3 Quality-improvement (QI) metrics for the outcomes of endovascular ischemic stroke treatment were published by a multisociety, multispecialty, international consensus group in 2013. 4 These QI metrics have been accepted at a national level in Great Britain and Ireland 5 but have yet to be included into stroke center accreditation requirements in the United States. Subsequent to the publication of the prior QI guidelines, eight randomized trials and several meta-analyses of EVT have been published. 6-20 These randomized trials have established EVT as standard of care when available, 5,21-23 and provide additional data on which to update the metrics and bench-

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“…Two recent studies of in-hours and out-of-hours thrombectomy from the United States [ 20 ] and Germany [ 21 ] reported similar delays in door-to-groin times (21 min and 20 min respectively), but also found worse early [ 21 ] and late [ 20 ] outcomes in patients treated out-of-hours. In contrast, another study from Germany, with no delay in door-to-groin time out-of-hours, found no difference in early or late outcomes following mechanical thrombectomy [ 22 ]. Outcomes were no different in- and out-of-hours in our hospital.…”

Section: Discussionmentioning

confidence: 99%

Mechanical thrombectomy: can it be safely delivered out of hours in the UK?

et al. 2020

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Background: Mechanical thrombectomy was approved by NICE as a treatment for stroke in 2016. However, most of the evidence is from studies conducted during working hours. Only few centres in the UK perform thrombectomies out-of-hours. The Royal Stoke University Hospital (RSUH) has offered thrombectomies over 24 h (24/7) since 2010. The aim of this service review is to compare the outcomes for patients treated in regular working hours to those treated outside normal working hours within this unit. Methods: This retrospective service analysis includes all patients treated with mechanical thrombectomy at RSUH since the start of the service in January 2010 to June 2019. Data on key demographics, timings, procedural complications, and long-term outcomes including death and disability at 90 days were collected. In-hours was defined as the time between 8:00-17:00 h, Monday to Friday; out-of-hours was defined as any time outside this period. Results: In total, 516 mechanical thrombectomies were performed in this time period; data were available on 501 of these. Successful recanalization (TICI 2b/3) was achieved in 86% of patients. By 90 days 96 (19%) had died and 234 (47%) were functionally independent (modified Rankin Scale score ≤ 2). 211 (42%) of the procedures were performed in-hours and 290 (58%) out-of-hours. Door-to-CT and door-to-groin times were significantly longer outof-hours than in-hours, but thrombectomy duration was significantly shorter. There were no significant differences in complications and short-and long-term outcomes. Conclusion: Mechanical thrombectomy was delivered safely and effectively 24/7 in this UK hospital, with no difference in clinical outcomes.

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Weekend effect in endovascular stroke treatment: do treatment decisions, procedural times, and outcome depend on time of admission?

Abstract: It is possible to produce competitive procedural times regardless of the time of admission and to prevent a treatment decision bias when standard operating procedures are applied consistently.

Cited by 16 publications

References 19 publications

A multicenter study evaluating the frequency and time requirement of mechanical thrombectomy

A multicenter study evaluating the frequency and time requirement of mechanical thrombectomy

Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke

Mechanical thrombectomy: can it be safely delivered out of hours in the UK?

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