NEUROLOGY 2005;64:2115-2120
© 2005 American Academy of Neurology
Time to hospital arrival, use of thrombolytics, and in-hospital outcomes in ischemic stroke
A. I. Qureshi, MD,
J. F. Kirmani, MD,
M. A. Sayed, MD,
A. Safdar, MD,
S. Ahmed, MD,
R. Ferguson, MD,
L. A. Hershey, MD,
K. J. Qazi, MD for the Buffalo Metropolitan Area and Erie County Stroke Study Group
From the Zeenat Qureshi Stroke Research Center, Department of Neurology and Neurosciences (Drs. Qureshi, Kirmani, Safdar, and Ahmed), University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, Department of Neurology, Epilepsy, and Sleep (Dr. Sayed), Cleveland Clinic, OH, and Departments of Medicine (Dr. Qureshi) and Neurology (Drs. Ferguson and Hershey), State University of New York, Buffalo.
Address correspondence and reprint requests to Dr Qureshi, 90 Bergen St., DOC-8100, Newark, NJ 07103; e-mail: aiqureshi{at}hotmail.com
Objective: To determine the interval between symptom onset and hospital arrival and its relationship to baseline clinical characteristics, use of thrombolysis, and in-hospital outcomes in patients with acute ischemic stroke admitted to the 11 hospitals in the Buffalo metropolitan area and Erie County.
Methods: The medical records of 1,590 patients were reviewed to determine the severity of the neurologic deficits (NIH Stroke Scale [NIHSS]), in-hospital mortality, favorable outcome (modified Rankin Scale score of  2 at discharge), and strata of time interval between symptom onset and hospital arrival.
Results: The time interval between symptom onset and hospital arrival was 0 to 3 hours in 337 (21%) patients, 3 to 6 hours in 177 (11%) patients, 6 to 24 hours in 301 (19%) patients, >24 hours in 420 (26%) patients, and undetermined in 355 (22%) patients. IV (n = 23) and intra-arterial (n = 4) thrombolysis was used in 27 (8%) of the 337 patients that presented within 3 hours of symptom onset. In 1,235 patients with known time interval between symptom onset and hospital arrival, an association (p = 0.008) was observed between strata of increasing time interval and higher proportion of favorable outcomes at discharge. The initial NIHSS score was higher with decreasing interval between symptom onset and hospital arrival (p < 0.0001).
Conclusions: A small proportion of patients who present within 3 hours of symptom onset receive thrombolytic therapy. The observation that patients with more severe neurologic deficits and subsequently worse in-hospital outcomes appear to present early after symptom onset to the hospital may have implications for clinical studies.
Supported by the American Heart Association (New York Affiliate).
Received January 3, 2005. Accepted in final form March 14, 2005.
Related Article
-
June 28 Highlights
Neurology 2005 64: 1994-1995.
[Full Text]
[PDF]
This article has been cited by other articles:
|
|
|
|
 
J. H. Lichtman, E. Watanabe, N. B. Allen, S. B. Jones, J. Dostal, and L. B. Goldstein
Hospital Arrival Time and Intravenous t-PA Use in US Academic Medical Centers, 2001-2004
Stroke,
December 1, 2009;
40(12):
3845 - 3850.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M Wardlaw, P. A G Sandercock, and V. Murray
Should more patients with acute ischaemic stroke receive thrombolytic treatment?
BMJ,
November 11, 2009;
339(nov11_1):
b4584 - b4584.
[Full Text]
|
|
|
|
|
|
|
J A Hirsch, A J Yoo, R G Nogueira, L A Verduzco, L H Schwamm, J C Pryor, J D Rabinov, and R G Gonzalez
Case volumes of intra-arterial and intravenous treatment of ischemic stroke in the USA
JNIS,
July 3, 2009;
(2009)
jnis.2009.000166v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J Kendall
Thrombolysis for acute ischaemic stroke: a new challenge for emergency medicine
Emerg. Med. J.,
August 1, 2008;
25(8):
471 - 475.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Juhl Majersik, M. A. Smith, D. B. Zahuranec, B. N. Sanchez, and L. B. Morgenstern
Population-Based Analysis of the Impact of Expanding the Time Window for Acute Stroke Treatment
Stroke,
December 1, 2007;
38(12):
3213 - 3217.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. I. Qureshi, M. F. K. Suri, A. Nasar, J. F. Kirmani, M. A. Ezzeddine, A. A. Divani, and W. H. Giles
Changes in Cost and Outcome Among US Patients With Stroke Hospitalized in 1990 to 1991 and Those Hospitalized in 2000 to 2001
Stroke,
July 1, 2007;
38(7):
2180 - 2184.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al.
Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists.
Circulation,
May 22, 2007;
115(20):
e478 - e534.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al.
Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists
Stroke,
May 1, 2007;
38(5):
1655 - 1711.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. C. Tilley and W. R. Galpern
Screening Potential Therapies: Lessons Learned From New Paradigms Used in Parkinson Disease
Stroke,
February 1, 2007;
38(2):
800 - 803.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. L. Edwards
Using tPA for acute stroke in a rural setting
Neurology,
January 23, 2007;
68(4):
292 - 294.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. C. Goff Jr, L. Brass, L. T. Braun, J. B. Croft, J. D. Flesch, F. G.R. Fowkes, Y. Hong, V. Howard, S. Huston, S. F. Jencks, et al.
Essential Features of a Surveillance System to Support the Prevention and Management of Heart Disease and Stroke: A Scientific Statement From the American Heart Association Councils on Epidemiology and Prevention, Stroke, and Cardiovascular Nursing and the Interdisciplinary Working Groups on Quality of Care and Outcomes Research and Atherosclerotic Peripheral Vascular Disease
Circulation,
January 2, 2007;
115(1):
127 - 155.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H.-F. Li, X.-D. Pan, N. Sanossian, and B. Ovbiagele
Premorbid antiplatelet use and ischemic stroke outcomes.
Neurology,
November 14, 2006;
67(9):
1723 - 1723.
[Full Text]
[PDF]
|
|
|
|
