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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
Neurology 2005 64: 1994-1995.
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