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

Year 2019, Volume: 16 Issue: 1, 46 - 50, 22.03.2019

Murat Mert Atmaca

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

Abstract

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. 

Keywords

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

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