Effect of admission time on provision of acute stroke treatment at stroke units and stroke centers—An analysis of the Swiss Stroke Registry-Reference-Cited by-同舟云学术

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

Published:2022-04-27 Issue:2 Volume:7 Page:117-125
ISSN:2396-9873
Container-title:European Stroke Journal
language:en
Short-container-title:European Stroke Journal

Author:

Altersberger Valerian L¹^ORCID,Wright Patrick R²,Schaedelin Sabine A²,De Marchis Gian Marco¹^ORCID,Gensicke Henrik¹³,Engelter Stefan T¹³,Psychogios Marios⁴,Kahles Timo⁵^ORCID,Goeldlin Martina⁶^ORCID,Meinel Thomas R⁶^ORCID,Mordasini Pasquale⁷,Kaesmacher Johannes⁷,von Hessling Alexander⁸,Vehoff Jochen⁹,Weber Johannes⁹,Wegener Susanne¹⁰,Salmen Stephan¹¹,Sturzenegger Rolf¹²,Medlin Friedrich¹³,Berger Christian¹⁴,Schelosky Ludwig¹⁵,Renaud Susanne¹⁶,Niederhauser Julien¹⁷,Bonvin Christophe¹⁸,Schaerer Michael¹⁹,Mono Marie-Luise²⁰,Rodic Biljana²¹,Schwegler Guido²²,Peters Nils²³,Bolognese Manuel⁸,Luft Andreas R¹⁰²⁴,Cereda Carlo W²⁵,Kägi Georg⁶⁹,Michel Patrick²⁶,Carrera Emmanuel²⁷,Arnold Marcel⁶,Fischer Urs¹⁶,Nedeltchev Krassen⁵,Bonati Leo H¹^ORCID

Affiliation:

1. Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland

2. Clinical Trial Unit, University Hospital Basel and University of Basel, Basel, Switzerland

3. Neurorehabilitation, University of Basel and University Department of Geriatic Medicine FELIX PLATTER, University of Basel, Switzerland

4. Department of Neuroradiology, University Hospital Basel and University of Basel, Basel, Switzerland

5. Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland

6. Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland

7. University Institute of Diagnostic and Interventional Neuroradiology and University Institute of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital Inselspital Bern, and University of Bern, Bern, Switzerland

8. Cantonal Hospital Lucerne, Luzern, Switzerland

9. Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland

10. Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland

11. Department of Neurology, Spitalzentrum Biel, Biel, Switzerland

12. Cantonal hospital Graubuenden, Chur, Switzerland

13. Department of Internal Medicine, Stroke Unit and Division of Neurology, HFR Fribourg, Cantonal Hospital, Fribourg, Switzerland

14. Stroke Unit, Hospital Grabs, Grabs, Switzerland

15. Cantonal Hospital Muensterlingen, Munsterlingen, Switzerland

16. Stroke Unit and Division of Neurology, Neuchatel Hospital Network, Neuchatel, Switzerland

17. Stroke Unit, Hôpital Nyon, Switzerland

18. Spital Sion, Sion, Switzerland

19. Bürgerspital Solothurn, Solothurn, Switzerland

20. Stadtspital Triemli Zürich, Switzerland

21. Cantonal Hospital Winterthur, Winterthur, Switzerland

22. Spital Limmattal, Schlieren, Switzerland

23. Stroke Center, Hirslanden Hospital Zurich, Zurich, Switzerland

24. Cereneo Center for Neurology and Rehabilitation, Weggis, Switzerland

25. Stroke Center and Department of Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland

26. Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland

27. Department of Neurology, HUG Geneve, Geneve, Switzerland

Abstract

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.

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,Neurology (clinical)

Link

http://journals.sagepub.com/doi/pdf/10.1177/23969873221094408

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