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Non-office-hours admission affects intravenous thrombolysis treatment times and clinical outcome
  1. Thomas P Zonneveld1,
  2. Sami Curtze2,
  3. Sanne M Zinkstok1,
  4. Henrik Gensicke3,
  5. Solène Moulin4,
  6. Jan F Scheitz5,
  7. David J Seiffge3,
  8. Christian Hametner6,
  9. Mirjam R Heldner7,
  10. Christopher Traenka3,
  11. Hebun Erdur5,
  12. Irem Baharoglu1,
  13. Nicolas Martinez-Majander2,
  14. Alessandro Pezzini8,
  15. Andrea Zini9,
  16. Visnja Padjen10,
  17. Pamela N Correia11,
  18. Daniel Strbian2,
  19. Patrik Michel11,
  20. Yannick Béjot12,13,
  21. Marcel Arnold7,
  22. Didier Leys4,
  23. Peter Arthur Ringleb6,
  24. Turgut Tatlisumak2,14,15,
  25. Christian H Nolte5,
  26. Stefan T Engelter3,16,
  27. Paul J Nederkoorn1
  28. on behalf of the TRISP collaborators
  1. 1Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
  2. 2Department of Neurology, University of Helsinki, Helsinki, Finland
  3. 3The Stroke Center and Department of Neurology, University Hospital Basel, Basel, Switzerland
  4. 4Degenerative and Vascular Cognitive Disorders, Univ-Lille, Inserm U1171, Lille, France
  5. 5Department of Neurology, Center for Stroke Research Berlin and Berlin Institute of Health (BIH), Charité-Universitätsmedizin Berlin, Germany
  6. 6Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
  7. 7Department of Neurology, University Hospital Bern, Bern, Switzerland
  8. 8Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
  9. 9Stroke Unit, Department of Neuroscience, Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena, modena, Italy
  10. 10Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
  11. 11Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
  12. 12Department of Neurology, University Hospital, Dijon, France
  13. 13Dijon Stroke Registry, University of Burgundy, Dijon, France
  14. 14Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
  15. 15Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
  16. 16Neurorehabilitation Unit, University of Basel and University Center for Medicine of Aging, Felix Platter Hospital, Basel, Switzerland
  1. Correspondence to Thomas P Zonneveld, Department of Neurology, Academic Medical Center, 1100 DD Amsterdam, The Netherlands; t.p.zonneveld{at}amc.nl

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Introduction

In patients treated with intravenous thrombolysis (IVT), an unfavourable ‘non-office-hours effect’ on door-to-needle time (DNT) and clinical outcome has been suggested. This effect has been attributed to a number of factors, mostly related to either less efficient logistics or less (experienced) staffing during non-office hours (NH). These factors could result in longer DNTs and more protocol violations and thus in worse clinical outcome. On the other hand, one could also argue that the workload during NH is lower, which could result in less time delays in the various diagnostic processes and thus in better clinical outcome. Our hypothesis is that admission during NH has a negative effect on onset-to-needle time (ONT), DNT and clinical outcome in IVT patients.

Methods

The ThRombolysis in Ischaemic Stroke Patients (TRISP) study is a collaboration of 12 European stroke centres and comprises a cohort of over 10 000 consecutive patients treated with IVT.1 We used data of patients treated up to 31 December 2014 (see online supplementary appendix file 1). We excluded patients receiving additional mechanical thrombectomy, those with symptom onset during hospital stay and those who woke up with stroke symptoms. Office hours (OH) and national or regional holidays were collected for each participating centre. Patients were categorised as admitted during NH if their door time was outside OH or during holidays. Outcome and safety measures were ONT, DNT, symptomatic intracerebral haemorrhage (according to European Cooperative Acute Stroke Study II criteria), 3-month mortality and 3-month functional outcome assessed with the modified Rankin Scale.

Supplementary file 1

[SP1.pdf]

Baseline characteristics and treatment times were compared between patients admitted during NH and OH using χ2 tests, Student’s t-tests and Mann-Whitney U tests, where appropriate. In the multivariate ONT and …

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