Impact of hospital admission during nonworking hours on patient outcomes after thrombolysis for stroke

Stroke. 2011 Sep;42(9):2521-5. doi: 10.1161/STROKEAHA.110.612697. Epub 2011 Jul 28.

Abstract

Background and purpose: Whether the time of hospital admission is relevant for short-term outcome after stroke is under debate and may depend on care facilities.

Methods: We retrospectively analyzed medical records from patients who received thrombolytic therapy within 4.5 hours of stroke onset in a stroke unit of the Charité-University Hospital Berlin (Charité; n=291) or within the stroke telemedicine (TEMPiS) network, comprising 12 community hospitals with telestroke units in Bavaria (n=616).

Results: Thrombolytic therapy was administered during nonworking hours in 59.5% (Charité) and 55.0% (TEMPiS) of patients. A trend toward a lower rate of symptomatic intracranial hemorrhage (3.4% versus 9.2%; P=0.053), clinical worsening (11.9% versus 19.7%; P=0.079), and 7-day mortality (3.4% versus 8.7%; P=0.073) after admission during working hours was seen at Charité. However, multivariable analysis did not show a significant impact of the time of admission on clinical worsening, symptomatic intracranial hemorrhage, or 7-day mortality in both cohorts. Thrombolysis based on brain computed tomography instead of magnetic resonance imaging (odds ratio=4.98, 95% CI, 1.09 to 22.7) and more severe National Institutes of Health Stroke Scale score on admission (odds ratio=1.15 per point; 95% CI, 1.07 to 1.24) were associated with 7-day mortality at Charité. National Institutes of Health Stroke Scale score on admission (odds ratio=1.13 per point; 95% CI, 1.06 to 1.19) and older age (odds ratio=1.05 per year; 95% CI, 1.004 to 1.09) were correlated with 7-day mortality in TEMPiS. National Institutes of Health Stroke Scale on admission was the only independent predictor of symptomatic intracranial hemorrhage or clinical worsening in both cohorts.

Conclusions: The majority of stroke patients received thrombolysis during nonworking hours. The time of hospital admission did not significantly influence the short-term outcome after thrombolysis.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Germany / epidemiology
  • Hospital Mortality
  • Humans
  • Intracranial Hemorrhages / diagnostic imaging
  • Intracranial Hemorrhages / mortality
  • Intracranial Hemorrhages / therapy
  • Male
  • Middle Aged
  • Patient Admission
  • Radiography
  • Retrospective Studies
  • Stroke / diagnostic imaging
  • Stroke / mortality
  • Stroke / therapy*
  • Thrombolytic Therapy*
  • Time Factors