The relationship between admission time, mode of transfer, and outcome in patients with stroke

Abstract

Background:Studies have shown that admission time and mode of transfer to hospital may affect outcomes in patients with acute ischemic stroke (AIS). We assessed the relationship between admission time [regular working (RW)/out-of-office (OO) hours], mode of transfer, and outcome in patients with AIS who received intravenous thrombolytic treatment (ITT) and/or mechanical thrombectomy (MT).

Materials and Methods:Forty-two patients with AIS who presented between September 1st, 2017, and October 1st, 2018, were included in the study. Patients were divided into groups according to admission hours, and mode of transfer to hospital. Demographic data, treatment, mRS score at admission and 1 month, change in mRS score, and symptom-onset-to-treatment (SOT) time were recorded.

 Results:The male/female ratio was 26/17. The mean age was 69.55 ±13.6 years. Eighteen patients (42.9%) received ITT, 16 (38.1%) MT, and 8 (19%) had both ITT and MT. Thirteen patients (31%) presented in RW hours and 29 (69%) in OO hours. Thirty patients (71.4%) arrived by ambulance, 7 (16.7%) by private transport, and 5 (11.9%) had stroke in hospital. Admission hour and mode of transfer had no effect on mRS scores at any time points. The SOT time was longer in patients admitted in OO hours (202.9 ±77.2 vs. 133.5±60.8 min; p=0.047) and was shorter in patients who had stroke in hospital (71.7±50.1 vs. 179.1±65.2 vs. 255±84.8 min; p=0.027).

Conclusions: Although the SOT time was shorter in patients who presented in RW hours and had stroke in hospital; admission time and mode of transfer to hospital did not negatively affect outcome in patients with AIS who were treated with ITT and/or MT.

Keywords

• Admission time
• mode of transfer
• acute ischemic stroke
• outcome
• intravenous thrombolytic treatment
• mechanical thrombectomy

İnme geçiren hastaların başvuru saatleri, transfer şekilleri ve sonlanımları arasındaki ilişki

Öz

Amaç: Çalışmalar, akut iskemik inme (Aİİ) tanılı hastaların hastaneye geliş zamanları ve geliş şeklinin sonlanım üzerinde etkili olabileceğini göstermektedir. Bu çalışmada, intravenöz trombolitik tedavi (İTT) uygulanan ve/veya mekanik trombektomi (MT) uygulanmak üzere yönlendirilen hastalarda mesai saatleri içinde veya dışında başvuru, hastaneye geliş şekli ve hastaların sonlanımı arasındaki ilişkiyi araştırmak istedim.

Yöntem: Hastanemize 1 Eylül 2017 ve 1 Ekim 2018 tarihleri arasında Aİİ ile başvuran İTT uygulanan ve/veya MT uygulanmak üzere yönlendirilen 42 erişkin hasta bu retrospektif çalışmaya dahil edilmiştir. Hastalar, mesai saatleri içinde ve dışında başvuranlar şeklinde ve ayrıca hastaneye geliş şekillerine göre gruplara ayrılmıştır.  Hastaların demografik özellikleri, hastalara uygulanan tedavi, hastaların girişteki ve 1.aydaki modifiye Rankin Skalası (mRS) skorları, mRS skorundaki değişimleri ve şikayet başlangıcı-tedavi (ŞBT) süreleri kaydedilmiştir.

Bulgular: Hastaların 26’sı erkek (%61,9) ve 17’si kadındı (%38,1). Yaş ortalaması 69,55 ±13,6 (32-93) yıl idi. On sekiz (%42,9) hastaya sadece İTT, 16 hastaya (%38,1) sadece MT, 8 (%19) hastaya İTT ve MT uygulandı. On üç hasta (%31) mesai saatleri içerisinde, 29 hasta (%69) mesai saatleri dışında başvurdu. Hastaların 30’u (%71,4) ambulans ile, 7’si (%16,7) kendi imkanları ile başvurdu, 5’i (%11,9) hastanede yatarken inme geçirdi. Hastaneye geliş zamanı ve geliş şekli ile hastaların giriş mRS skoru, 1. ay mRS skoru ve mRS skoru değişimi arasında bir ilişki bulunmadı. Mesai saatleri dışında başvuran hastalarda mesai saatleri içinde başvuranlara kıyasla ŞBT süreleri daha uzundu (202,9 ±77,2 dk vs 133,5±60,8 dk; p=0,047). Hastanede yatarken inme geçiren hastalarda ambulansla ve kendi imkanları ile gelenlere kıyasla ŞBT süreleri daha kısaydı (71,7±50,1 vs 179,1±65,2 vs 255±84,8 dk; p=0,027).

 

Sonuç:  Bu çalışmanın verilerine göre; ŞBT süreleri mesai saatleri içinde başvuranlarda ve hastanede inme geçirenlerde daha kısa olsa da; AİS ile başvuran, İTT uygulanan ve/veya MT uygulanmak üzere yönlendirilen hastalarda, hastaneye geliş zamanı ve geliş şekli hastaların sonlanımı üzerinde negatif bir etkiye sahip değildir. 

Anahtar Kelimeler

• Başvuru saati
• transfer şekli
• akut iskemik inme
• sonlanım
• intravenöz trombolitik tedavi
• mekanik trombektomi

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