Association of Time of Day With Outcomes Among Patients Triaged for a Suspected Severe Stroke in Nonurban Catalonia
Author:
García-Tornel Álvaro1ORCID, Flores Alan2ORCID, Terceño Mikel3, Cardona Pedro4ORCID, Amaro Sergi5ORCID, Gomis Meritxell6ORCID, Zaragoza Josep7, Krupinski Jerzy8, Gómez-Choco Manuel9ORCID, Mas Natalia10, Cocho Dolores11ORCID, Catena Esther12, Purroy Francesc13ORCID, Deck Matias1, Rubiera Marta1ORCID, Pagola Jorge1ORCID, Rodriguez-Luna David1ORCID, Juega Jesús1, Rodríguez-Villatoro Noelia1, Molina Carlos A.1ORCID, Soro Cristina14ORCID, Jimenez Xavier14ORCID, Salvat-Plana Mercè15ORCID, Dávalos Antoni6ORCID, Jovin Tudor G16ORCID, Abilleira Sonia15ORCID, Pérez de la Ossa Natalia6ORCID, Ribó Marc1ORCID, Sanjuan Estela, Santana Katherine, Maisterra Olga, Santamarina Estevo, Muchada Marian, Boned Sandra, Franco Antonio Palasi, Gadea Marta Olivé, Deck Matías, Requena Manuel, Sala Victoria, Muñoz Lucía, Millán Mónica, López-Cancio Elena, Dorado Laura, Hernández-Pérez María, Ciurans Jordi, Samaniego Daniela, Canento Tamara, Martin Lorena, Planas Anna, Broto Joaquin, Sorrentino Agustín, Paré Martí, Zhu Nuole, Garrido Alicia, Grau Laia, Crespo Ane Miren, Presas Silvia, Almendrote Miriam, Ramos Alba, Lucente Giuseppe, Ispierto Lourdes, Lozano Manuel, Becerra Juan Luis, Jiménez Marta, Rolán Dolores Vilas, Guanyabens Nicolas, Sanchez-Ojanguren Josep, Martínez-Piñeiro Alicia, Forcén Sara, Gea Mireia, Álvarez Marta, Ramos Anna, Lizarbe Manuel Domínguez, Guerra Rubio, Bragado Irene, Arbex Andrea, Rodríguez Luis, Bustamante Alejandro, Portela Pere Cardona, García Helena Quesada, Rodríguez Blanca Lara, Cayuela Nuria, Miró Julia, Marzal Clara, Paipa Andrés, Campoy Sergio, Núñez Ana, Arroyo Pablo, Besora Sarah, Adell Vanessa, Campdelacreu Jaume, Martí Montse Alemany, González Belén, Vila Laura Bau, Crespo Marta Fiter, Berbel Anna, Urbaneja Ma. Cristina Villaescusa, Guillen Núria, Vidal Nuria, Santamaria Patricia Valentina Vérez, Navarro Diego Herrero, Simó Marta, Falip Mercedes, Matas Elisabeth, Ochoa Neus Mongay, Gifreu Ariadna, Muñoz Albert, Romero Lucía, Portell Eduard, Perez Guillermo Hernández, Esteve F. Ruiz, Teixidor Silvia, Talavera Augusto Salazar, Gómez Roser, Nuin Xabier Urra, Vargas Martha, Chamorro Ángel, Llull Laura, Renú Arturo, Rudilosso Salvatore, del Valle Raquel Sánchez, Ariño Helena, Solà Nuria, la Puma Delón, Gil Francisco, Gómez Juan Bernardo, Matos Nuria, Falgàs Neus, Borrego Sergi, Sánchez Almudena, Balasa Mircea, Montejo Carmen, Guasp Mar, Reyes David, Cervilla Pablo Sánchez, Contador Jose Miguel, Monge Victor Augusto Vera, Ramos Oscar, Rodríguez Alejandro, Campello Ana Rodríguez, Ballester Gemma Romeral, Trujillano Mireia Llop, Steinhauer Eva Giralt, Godia Elisa Cuadrado, Santiago Angel Javier Ois, Conde Jordi Jimenez, Fábregas Joan Martí, Guisado Daniel, Prats Luís, Camps Pol, Delgado Raquel, Domeño Alejandro Martínez, Marín Rebeca, Cànovas David, Estela Jordi, Ros Marta, Aranceta Sonsoles, Espinosa Jordi, Rubio Marta, Lafuente Cristina, Barrachina Oriol, Anguita Alicia, Reverter Anna, García Carmen, Sansa Gemma, Hervas Mariona, Crosas Monica, Delgado Tania, Folch Dra Sonia Huertas, Gamito Gemma Muñoz, Alvarez Josep Trenado, Subirana Teresa, Molina Jessica, Besora Sarah, Romero Laura Comes, Valls Gemma Guardia, Jover Miriam, Sotova Javier Joaquín, García Sánchez Sonia Mª, Valenzuela Sebastian, Mengual Juan José, Font M. Àngels, Gómez Ruiz Mª Isabel, Zubizarreta Irati, González Susana Fernández, Gubieras Laura, Cobos Carmen E., Romo Luis Mena, Caballol Nuria, Cano Luis, Leal Joaquín Serena, Blas Yolanda Silva, Trigo Irene Bragado, Viturro Saima Bashir, Albiñana Laura Pardo, Garrido Montserrat Reina, Cazcarra Carla Marco, Uscamaita Karol Enrique, Márquez Fabian, Coll Cristina, Villlas Mar Irida Lloret, Vila Berta Solano, Perna Berta Alemany, Domínguezl Daniel López, de Lera Mercedes, Foraster Anna Cots, Monge Victor Augusto Vera, Bojaryn Urszula, Benabdelhak Ikram, Capdevila Gerard Mauri, Montesinos Jordi Sanahuja, Vázquez Daniel, Hervás José Vicente, González Cristina, Quílez Alejandro, Pascual Mikel Vicente, Ruiz María, Riba Yolanda, Villar M. Pilar Gil, García Cristina, Roig Xavier Ustrell, Mora Mònica Baldrich, Guinjoan Anna Pellisé, Borras Judit, Martínez Alba Mañé, Marés Rafael, Viñas i Gaya Jaume, Seró Laia, Rodríguez Paula, Castilho Gislaine, Ortega Angela Monterde, Reverté Silvia, Baiges Joan Josep, Ozaeta Gisela Martín, Escalante Sonia, Belloch Patricia Esteve, Payo Iago, Salvado Júlia Saura, Soler Insa Josep M, Vilamala Ester Tio, Navarro Josep Abos, Tabuenca Héctor Cruz, Sánchez Tamara Canento, Ros Marta, Matos Nuria, Roldán Elisabet, Rubiol Elsa Puiggrós, Franquet Elisabet, Fuentes Lidia, Donaire Javier, Martí Elena, Giménez Laura, Vázquez Junior Gil, Ambrós Eloisa Nieto Clara Gris, Rodríguez Puri, Oletta José Félix, Mellado Pilar Pons, Gómez Bárbara, Raileau Vergilin, Pardina Oscar, Mercadal Jordi, López-Diéguez María, Pérez Pilar, Gabarró Lourdes, Orriols María, Molina José Carlos, Canet Joan Josep, Roca Mireia, Álvaro Muriel, Boneu Francesc, Giménez Georgina, Albà Jaume, Gibert Francesc, Garcia Jéssica, Barragan Patricia, Jurado Gustavo, Pascual_Medicina Interna Vanesa, Ortega Josep Sabaté, Solano Joan Amaurys Martínez, Fernández Víctor, Torres Mónica, Alvaredo Ana Belén Montero, Parejo Laura Redondo, Aragonés Josep Maria, Bullón Anna, Loste Cora, González Paula, Bejarano Neker, Sanchez Francisco, Lucchetti Gianni, Pla Xavier, Gimeno Dr Javier, Reynaga Esteban, Barcons Montse, Celedón Gabriel, Ortiz Juan, Anastasovski Dr Goran, Mascaró Dr Oscar, de los Ríos Dr Javier Diez, Feliu Meritxell, Ribera Anna, Ruiz Cristhian, Corominas Gerard, Nunes Dra Daniella, Roca Claudia, Latorre Nadina, Yataco Lizbeth, Cruz Maricelys, Blanco Nerea, Castejón Santiago, Sunyer Claustre Pont, Garcia Jordi Espinosa, Martin Rodrigo Paz, de Luis Sanchez Albert, Vivas Dolores Espinosa, Molina Juan Valencia, Palome Planels, Chaume Laia Tomas, Vilella Ares Villagrasa, Bustamante Marco, Boltes Anunciación, Rodríguez Fernando, Arrieta Itziar, Molist Jordi Ciurans, Andreu Barnés, Soler Ernest Palomeras, Buscà Nicolau Guanyabens, López Manuel Daza, Farreres Jordi Bigas, Ruiz Virginia Casado, Batiste Desiree Muriana, Sanz Cartagena Mª Pilar, de Vega Eulalia Cabot, Real Josep Bassa, Roman Hector Pelaez, Socolich César, Alonso Camp Josep Mª, Orgaz Antonio Tomás Cano, Fossas Felip Mª Pilar, Morón Nicolás, Bacca Sandra, Molina Mauricio, Casarramona Francesc, Elias Lorena, Bukaei Muhammad Zidane, Gutierrez Jose Antonio Martos, Escuin Judith Lopez, Olaizola Cristina, Vargas Yolexis López, Oyonarte Juan Jiménez, Soultana Rashida, Golpe Eduardo Sanjurjo, Salvador Esther, Vila Guillem, Serrano Marcos, Claverol Matilde Nuria López, Lamolla Marian, Amate Miquel, Rodriguez Adriana, Romero Ruth, del Carpio Montgomery, Hernandez Ana Isabel, Martín Julián, Rosas M Carmen, Nogueroles Antonio, Encarnación Sorilandy, Robles Augusto, Herrera Jose Antonio, Gavilán Roger, Mameghani Toghrol, Araujo Gastón, Morales M.Angeles Garrido, Segui Enric Ramon Albert, Climent Eva Fernandez, Pujol Francesc Paris, Seira Mireia Judit Garrofé, Pía Lucía Gómez, Nuñez Fernando Salleres, Peñalver Cristina Aguar, Lopes Cristina Vaz, Tasa Elisenda Ribera, Vilchez Carmen Repullo, Zambrana Modesto Sánchez, Ribas Beatriu Suescun, Panés Inés Vilà, Planavila Montserrat Vila, Lorenzo Alicia Vaqueiro, Guixes Meritxell Sabartés, Medina Jorge, Sambrano David, Zamarreño Javi, Pirela Carmen, Vélez Paola, Cajamarca Luis, Pérez Honey, Martínez Yarles, Gonçalves Jesus Alexander, Regordosa Carles, Mormeneo Claudia, Griu Laura, Colina Maria Francia, Farik Enric, Duch Dolors Carrión, Badenas Carles, Bernal Oscar, Agramunt Núria, Morales Shyrlei, Reynoso Victoria, Guerrero Miguel, Cid Primitivo Romera, Folqué Mònica, Pedroza Claudia, Hachem Adnan, Martínez Íñigo Soteras, García Xavier Verdera, Amorós Mercè López, Subirós Xavier Costa, Benet Marta Cufí, Van Eendenburg Cecile, Osuna Teresa, Santos Dra Gina, Pallisera Dra Mireia, Oliva Dr Lluís Gonzalo, Sanchez Dra Gemma, Basurto Dr Xavier, Vivoda Dr Ludgi, Van der Kleyn Dr Richard, Robles Dra Laura, Barranco Ana Cabanelas, Almendros Mª Cruz, Oliveras Marc Pérez, Álvarez Amelia Fernández, Rybyeva Maria, Viñas Antoni, Barcons Maria, Tavera Joaquim Danès Alberto, Burbano Pablo, López Cintie, Cruz David, Bisbe Paula, Fernández Nora, Palacio Juan Carlos, Fraiz Eduardo, Aguiló Oriol, Amorodjo Rollmy, Velázquez John, Sánchez Elena, Español Jaume, Perez de Celis Judit, Coll Anna, Díaz Glòria, Vergés i Sala Margarida, Casas Capdevila Mª Ángels, Ferrini Yosmairy Yoselin, Gorriz Aitor, Navarro Diego-Javier Cucurell, Velásquez Dulce, Pla Soler Jaume, González Josep, Higuera Julian David, Cuellar Lina, Miniello Liza Margarita, Pujol Lluis, Cracan Sorin, Vives Mora, Angela M, Lopez Lopez, Molist Montse Gorchs, Anna Delofeu, Muñoz Silvia Solà, Yolanda Ferreres, Pujalte Carol, Marín Elisabeth Téllez, Casas Yolanda Font, Luque Sara Hernández, Sendra Joaquim Mejias, Valero Francesca Mellado, Escala Campos, De Lacanal Galup, Diaz Lopez, Paramio Castillo, Estopà Català, Moreda Español, Majo Calafell, Almeida Carballo, Naval Castro, Elena M, Ruiz Cregut, Lluis Pere, Font Deulofeu, Sanjuan Fabregat, Pere Joan, Gorchs Fontquerni, Bellés Forés, Antoni Joan, Herrera Gomez, Carlos Juan, Prades Hijazo, Torvisco Itzaina, Rovira Marti, Gonzalez Obiols, Cavero Olive, Gil Querol, Soledad M, Rodriguez Rico, Sambernardo Rios, Molina Ropero, Ramon Jose, Valero Sanchez, Arevalo Santos, Jose Maria, Garcia Soto, Angeles Maria, Escribano Tebar, Garcia Torres, José Pedro, Carrion Verdes, Isabel M, Lopez Verge, Jose Juan, Canela Lopez, Angeles M, Guarque Lucas, Alvarez Morales, Arnulfo Jorge, Fornieles Morell, Gomez Subirats, Teresa Maria, Masa, Miquel Torello, Lopez Val, Mercedes Maria, Reyes Palmero, Manuel Juan, Forne Rodriguez, Turiel Ruana, Gonzalez Sanchez, Gornals Sebastia, Rico Abrio, Falip Albert Gual, Oliveros Aznar, Perotti Brugues, Molinero Calvet, Franco Catells, Medina Corrales, Miro Daroca, Marquez Duran, Pradas Feliu, Casanova Figueras, Tortajada Garcia, Gallego Grajera, del Mar Azahara, Arroyo Las, de Jesus Dulcenombre, Sanz Laserreta, Vidal Llambrich, Corral Monllao, de la Cruz Morales, Blanco Moreno, Orgaz Orejuela, Suazo Piñana, Minguillon Pons, Gómez Rodríguez, Carlos José, Pereira Rodriguez, Porcel, Anna Sedo, Villar Sevil, Lopez Sierra, Romero Torres, Calveres, Anna Trepat, Arnella Ventura, Gil Acera, Teresa M, Vico Biesot, Galea Castro, Maria Rosa, Chafer Escorcia, Antonio Juan, Moreda Español, Faure Gil, Luque Hernandez, Delgado Jimenez, Gay Mallafre, Angel M., Sanzo Olivares, Fondevila Pubill, Fort Sabate, Agámez Segovia, Carlos Antonio, Longaretti Turata, Hernandez Valle, Guixens Trayner, Valor Aguilar, Alvarez Aguirre, Naval Alastrue, Baquero Alferez, Marne Alonso, Orozco Aloy, Colino Alvarez, Peñuela Alvarez, Cirilo Ameller, Vanessa Maria, Guerrero Andujar, Remedios Estefania, Sillero Auladell, Sorbet Azcarate, Genesca Basany, Barduena Benavent, Tudela Benito, Pardo Blanch, Pla Boluda, Gonzalez Bonilla, Serramalera Bru, Andreu Burnat, Calvo-Rayo Caballero, Casellas Calvo, Mombiela Camps, Bresme Cano, Fernandez Carcelen, Solà Caro, Matavacas Casasas, Bolado Castanedo, Cortina Cerdeña, Jane Abella, Borrego Laia Collado, Orri Colom, Vilanova Comellas, Sole Conillera, Torres Cots, Estepa Cuchi, de Sostoa Graell Marc, del Rio Lopez Laura, Compte Delgado, Bueno Diaz, Maneiro Diaz, Lucia Andrea, Palau Domenech, Carme M., Carasso Duran, Javier Pablo, Marquez Duran, Abidi El, Martin Escoda, Casanovas Esteve, Perez Fernandez, Quintero Ferre, Escobar Flores, Abad Fontcuberta, del Valle Fortes, del Valle Fortes, Luisa Mª, Quesada Franco, Maria Sara, Romero Franco, Teresa Maria, Francisco Gallego, Gala Gamiz, Castañeda Garcia, Rodriguez Garcia, Gemma Casajuana, Arroyo Gomez, Girbau Gomez, Fernandez Gonzalez, Gonzalez Gonzalez, Gonzalez Gonzalez, Lopez Gonzalez, Obeso Gual, Blanco Guerrero, Roca Guillemas, Eudaldo Guillermo, Hernandez Sebastia, Covas Homar, Alvarez Hostench, Royo Huerta, Barcelo Ibañez, Cruz Izquiero, Etxetxikia Jaione Urdangarin, Gimenez Juárez, Alami Khlifi, Gasco Laparra, Moreales Lara, Arroyo Las, de Jesus Dulcenombre, Medina Lasaosa, Lourdes Maria, Cava Lazaro, Berrar Leon, Maturana López, Ramirez Lopez, Romero López, Marco Lorente, Martin Lorenzo, Casals Lozano, Nicola Lujan, Diaz Madrid, Antonio Jose, Morales Maria Teresa Peris, Clemente Marti, Castaño Martinez, Natanael David, Gamez Martinez, Gonzalez Martinez, Quesada Martinez, de la Cabeza Maria, Fusté Marzà, Lasheras Melendo, Mestre Miralles, Pastalle Montserrat Puig, Vidal Montserrate, Mellado Mora, Ponce Morales, Fornieles Morell, Cabre Morera, Vivet Morera, Souza Mundi, Quiles Muñoz, Rosa Navea, Iglesias Neira, Asuncion M, Manrique Nuñez, Pilar Mª, Martinez Obiols, Reig Pallares, Torres Partegas, Berengueras Pascual, Gamez Perez, Oset Perez, Restrepo Perez, Alejandra Maria, Yeste Planas, Mangado Planells, Minguillon Pons, Carbonell Puertas, Blanco Quinteiro, Benavente Rebollar, Fernandez Recasens, Gomez Reyes, del Carmen Maria, Pou Roca, Ferrer Rodriguez, Franco Rodriguez, Fuertes Rodriguez, Muñoz Rodriguez, Navarro Rodriguez, Iniesta Roig, Gracia Romero, Brunet Rovira, de Eugenio Rovira, Baena Rubio, Llorens Ruiz, Llamazares Sala, Alaez San Juan, Segura Sanchez, Soldevilla Santasusana, Salmeron Sanz, Perez Segura, Balcells Serra, Dumitras Sorina, Montoya Teixidor, Vicente Tena, Salinas Tierno, Ines Ester, Testa Toledo, Figueras Tomàs, Ruperez Tomas, Garcia-Penche Torrano, Esparza Torres, Blanco Vazquez, De la Paz Vazquez, Gil Vazquez, Gonzalez Vazquez, Meler Vidal, Cots Vilalta, Jimenez Vilches, Jose Maria, Fernandez Visser, Gavin Viu, Vives Vives, Jimenez Carmona, Jose Francisco, Vilches Galobardes, Gomez Gonzalez, Manzanera Jodar, Cortes Marimon, Orive Marrodan, Bosch Martin, Jose Maria, Lopez Martorell, Roca Millares, Jesus M, Guri Miralles, Hernandez Muliterno, Oliva Muñoz, Pujol Pons, Conde Postius, Arruñada Prieto, Antonio Jose, Mathé Quintana, Mata Rosell, Alvarez Aguirre, Alvarez Alvarin, Flores Arrufat, Pago Bañuelos, Andreu Burnat, Vilar Campo, Hidalgo Cardus, Gil Castello, Gloria Maria, Montsesinos Castrillo, Estopà Català, Garces Clave, Sanroma Comes, Sequi Descalzo, Ricol Errando, Campillo Escudero, del Mar Maria, Alvarez Fernandez, Gomez Fernandez, Perez Fernandez, Espinosa Franch, Graells Freixes, Plaza Garcia, Gallego Garcia-Marron, Simancas Hernandez, Covas Homar, Royo Huerta, Armas Jaraba, Ramos Jimenez, Canela Lopez, Angeles M, Lopez Lopez, Oganissian Lopez, Romero Madrona, Rosa M, Millan Martinez, Morón Martínez, Encinas Merchan, Fornieles Morell, Jimenez Moreno, Rico Muñoz, Rodriguez Navarro, Ibañez Nogales, Maria Rita, Viera Novillo, Torrabadella Parella, Alba Mari, Villar Pera, Montserrat Carla, Carbonell Puertas, Miralles Rabella, Trilles Ramis, Ortiz Ribera, Fuertes Rodriguez, Gonzalez Sanchez, Perez Sastre, Perez Segura, Borrega Soro, Garcia Soto, Angeles Maria, Fores Tapia, Bernad Tellez, Alvarez Trenado, Moreda Español, Martin Felix, Perez Herrero, Manzanera Jodar, Fuster Lanau, Gomariz Lopez, Orive Marrodan, Bosch Martin, Jose Maria, Guri Miralles, Oliva Muñoz, Lozano Pardo, Pujol Pons, Altimiras Quintana, Lopez Ventosa, Damian Almodovar, Colino Alvarez, Monterroso Alvarez, Comas Arambudo, Garzon Boullon, Capella Burgos, Garcia Campuzano, Del Mar Maria, Olivas Capdevila, Fernandez Carcelen, Solà Caro, Marti Carre, Isabel Clara, Bacaicoa Carretero, Gil Castello, Gloria Maria, Montsesinos Castrillo, Calderon Cazorla, Osuna Chacon, Planas Cortes, Olio Cortit, Estany Delhomme, Carasso Duran, Javier Pablo, Campillo Escudero, del Mar Maria, Martinez Fructuos, Lopez Garcia, Luis Pascual, Plaza Garcia, Vallve Genis Amill, Arroyo Gomez, Girbau Gomez, Muñoz Gonzalez, Ventura Hernaez, Covas Homar, Gimenez Lavernia, Rojo Martin, Medina Martínez, Millan Martinez, Barrera Mayol, Pi Mercader, Dalmau Merino, Campodarbe Miguel, Pastalle Montserrat Puig, de la Cruz Morales, Fornieles Morell, Sanchez Moreno, Javier Francisco, Reig Pallares, Torrabadella Parella, Alba Mari, Barrameda Penela, Ajenjo Prieto, Benavente Rebollar, Pareja Rodriguez, Piñar Rodríguez, Javier Francisco, Tello Rodriguez, Pereda Romero, Saborido Sainz, Martin Santacana, Martinez Santos, Chavez Sierra, Testa Toledo, Figueras Tomàs, Garcia Torres, José Pedro, Torres Turbau, Domenech Vicente, Esteo Villena, Pertegaz Vives, Gonzalez Baena, Pont Bagaria, Sanchez Beltran, Alarcon Bonet, Ballescà Borch, Clanchet Buhils, Garcia Closa, Carril Colomina, Sanchez Cristina Fernandez, Toledo Edurne Judith Fernandez, Rodriguez Espases, Resa Espert, Xavier F, Sol Fernández, Lugo Gonzalez, Llesera Gracia, Lendinez Herrada, Liesa Juliench, Alicia Sandra, Ortega Lopez, Yuste Lopez, Villanueva Lozano, Soto Lucia Sola, Castellano Madrid, Cano Megias, Jesus Daniel, Ponce Montasell, Sospedra Montesinos, Martinez Moya, Herrera Muñoz, Isabel M, Fernandez Ocaña, Jose Maria, Bernal Palau, Sole Perez, Carbonell Ramon, Lop Ribas, López Rubio, Lopez Rueda, Castaño Sabat, Lara Sabata, Ramírez Salmerón, Gornals Sebastia, Creus Serra, Dalmau Serrano, Mainero Sumasi, Gabriel Gonzalo, Masa Torello, Primo Valencia, Muñoz Ana Maria Viñuales, Roig Josep, Hidalgo Verònica
Affiliation:
1. Stroke Unit, Department of Neurology, Hospital Vall d’Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Spain (A.G.-T., M.D., M. Rubiera., J.P., D.R.L., J.J., N.R.V., C.A.M., M. Ribó). 2. Department of Neurology, Hospital Universitari Joan XXIII, Tarragona, Spain (A.F.). 3. Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain (M.T.). 4. Stroke Unit, Hospital Universitari Bellvitge, L’Hospitalet de Llobregat, Spain (P.C.). 5. Stroke Unit, Hospital Clínic, Barcelona, Spain (S.A.). 6. Stroke Unit, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain (M.G., A.D., N.P.d.l.O.). 7. Department of Neurology, Hospital Verge de la Cinta, Tortosa, Spain (J.Z.). 8. Department of Neurology, Hospital Mútua Terrassa, Spain (J.K.). 9. Department of Neurology, Hospital Moisés Broggi, Sant Joan Despí, Spain (M.G.-C.). 10. Department of Neurology, Hospital Sant Joan de Déu - Fundació Althaia, Manresa, Spain (N.M.). 11. Department of Neurology, Hospital General Granollers, Spain (D.C.). 12. Department of Neurology, Consorci Sanitari Alt Penedès-Garraf, Spain (E.C.). 13. Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P.). 14. Sistema d’Emergències Mèdiques, Barcelona, Spain (C.S., X.J.). 15. Stroke Program, Catalan Health Department, Agency for Health Quality and Assesment of Catalonia (AQuAS), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain (M.S.-P., S.A.). 16. Neurological Institute, Cooper University Hospital, Camden, NJ (T.G.J.).
Abstract
Background:
We aim to assess whether time of day modified the treatment effect in the RACECAT trial (Direct Transfer to an Endovascular Center Compared to Transfer to the Closest Stroke Center in Acute Stroke Patients With Suspected Large Vessel Occlusion Trial), a cluster-randomized trial that did not demonstrate the benefit of direct transportation to a thrombectomy-capable center versus nearest local stroke center for patients with a suspected large vessel stroke triaged in nonurban Catalonia between March 2017 and June 2020.
Methods:
We performed a post hoc analysis of RACECAT to evaluate if the association between initial transport routing and functional outcome differed according to trial enrollment time: daytime (8:00
am
–8:59
pm
) and nighttime (9:00
pm
–7:59
am
). Primary outcome was disability at 90 days, as assessed by the shift analysis on the modified Rankin Scale score, in patients with ischemic stroke. Subgroup analyses according to stroke subtype were evaluated.
Results:
We included 949 patients with an ischemic stroke, of whom 258 patients(27%) were enrolled during nighttime. Among patients enrolled during nighttime, direct transport to a thrombectomy-capable center was associated with lower degrees of disability at 90 days (adjusted common odds ratio [acOR], 1.620 [95% CI, 1.020–2.551]); no significant difference between trial groups was present during daytime (acOR, 0.890 [95% CI, 0.680–1.163];
P
interaction
=0.014). Influence of nighttime on the treatment effect was only evident in patients with large vessel occlusion(daytime, acOR 0.766 [95% CI, 0.548–1.072]; nighttime, acOR, 1.785 [95% CI, 1.024–3.112] ;
P
interaction
<0.01); no heterogeneity was observed for other stroke subtypes (
P
interaction
>0.1 for all comparisons). We observed longer delays in alteplase administration, interhospital transfers, and mechanical thrombectomy initiation during nighttime in patients allocated to local stroke centers.
Conclusions:
Among patients evaluated during nighttime for a suspected acute severe stroke in non-urban areas of Catalonia, direct transport to a thrombectomy-capable center was associated with lower degrees of disability at 90 days. This association was only evident in patients with confirmed large vessel occlusion on vascular imaging. Time delays in alteplase administration and interhospital transfers might mediate the observed differences in clinical outcome.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02795962.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)
Cited by
5 articles.
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