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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. 1 Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
  2. 2 Department of Neurology, University of Helsinki, Helsinki, Finland
  3. 3 The Stroke Center and Department of Neurology, University Hospital Basel, Basel, Switzerland
  4. 4 Degenerative and Vascular Cognitive Disorders, Univ-Lille, Inserm U1171, Lille, France
  5. 5 Department of Neurology, Center for Stroke Research Berlin and Berlin Institute of Health (BIH), Charité-Universitätsmedizin Berlin, Germany
  6. 6 Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
  7. 7 Department of Neurology, University Hospital Bern, Bern, Switzerland
  8. 8 Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
  9. 9 Stroke Unit, Department of Neuroscience, Nuovo Ospedale Civile S. Agostino-Estense, AUSL Modena, modena, Italy
  10. 10 Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
  11. 11 Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
  12. 12 Department of Neurology, University Hospital, Dijon, France
  13. 13 Dijon Stroke Registry, University of Burgundy, Dijon, France
  14. 14 Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
  15. 15 Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
  16. 16 Neurorehabilitation 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}

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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.


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


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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  • Contributors TPZ, STE and PJN planned the study. All authors contributed to data acquisition. TPZ, SMZ and PJN analysed the data. TPZ wrote the first draft; all authors revised the draft paper. TPZ submitted the study and is responsible for the overall content as guarantor.

  • Funding AZ has received speaker fees from Boehringer-Ingelheim and consulting fees from Medtronic. PM has received through his institution (CHUV) within the last 3 years: research grants from the Swiss National Science Foundation, the Swiss Heart Foundation, and Cardiomet-CHUV; speaker fees from Bayer, Boehringer-Ingelheim, Covidien and St. Jude Medical; honoraria from scientific advisory boards from Boehringer-Ingelheim, Bayer, Pfizer; consulting fees from Pierre-Fabre. He also has received travel support from Boehringer-Ingelheim and Bayer. He uses all this support for stroke education and research. YB served on scientific advisory boards or received speaker honoraria for Boehringer-Ingelheim France, AstraZeneca, Daiichi-Sankyo, BMS, Pfizer, MSD, and Bayer. MA received honoraria for giving lectures and serving on advisory boards for Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer, and Covidien. D.L. participated during the last five years to advisory boards, symposia or trials sponsored by Sanofi Aventis, BMS, AstraZeneca, Boehringer-Ingelheim, Servier, Ebewe, CoLucid Pharm, Brainsgate, Photothera, Lundbeck, GSK, Bayer, Pfizer, and Allergan (honorarium paid to Adrinord or research account of the hospital) and was an associated editor of the Journal of Neurology, Neurosurgery and Psychiatry 2004-2010 (personal financial compensation). P.R. received speaker honoraria (<10.000€ / 2 years) from Boehringer Ingelheim. TT: Research contracts with Boehringer-Ingelheim, BrainsGate, Pfizer, and Bayer. Advisory board memberships: Boehringer-Ingelheim, Medfield Diagnostics, Pfizer, and Bayer. CHN. has received [through his institution (Charité)] within the last three years: research grants from German Ministry of research and education, and received funding for travel or speaker honoraria from Bayer, Boehringer Ingelheim, BMS/Pfizer, and Sanofi. STE has received funding for travel or speaker honoraria from Bayer and Boehringer Ingelheim, he has served on scientific advisory boards for Bayer, Boehringer Ingelheim, BMS/Pfizer, and Covidien and on the editorial board of Stroke. He has received an educational grant from Pfizer and research support from the Science Funds [Wissenschaftsfonds] of the University Hospital Basel, the Swiss Heart Foundation, and the Swiss National Science Foundation. PJN has received consulting fees from Boehringer Ingelheim.

  • Competing interests None declared.

  • Ethics approval Approval was obtained from ethical committees in each participating centre.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Collaborators TRISP collaborators are listed in a supplementary file.