BACKGROUND: Stroke outcomes are worse in patients admitted at nonworking hours (NWH), but whether this is also true in patients treated with intravenous (i.v.) thrombolysis has not been definitely proven. OBJECTIVE: Our aim was to test the hypothesis that stroke patients treated by i.v. rt-PA at NWH have a worse outcome than those treated at working hours (WH). METHODS: We compared outcomes at 7 days and at 3 months, between patients treated at NWH and at WH in the stroke unit of the Lille University Hospital. RESULTS: Of 252 consecutive patients [median age: 69 years; 132 men (52.4%); median National Institutes of Health Stroke Scale score: 14; median onset-to-needle time: 150 min], 134 (53.2%) were treated at NWH. They did not differ for baseline characteristics and proportion of patients with modified Rankin Scale scores 0-1 and 0-2 at 3 months. Patients treated at WH were more likely to die before 7 days (12.7 vs. 4.5%; adjusted odds ratio: 3.6; 95% confidence interval: 1.2-10.4) and at 3 months (21.6 vs. 11.4%; adjusted odds ratio: 2.2; 95% confidence interval: 1.02-4.7). The causes of death did not differ between NWH and WH. At NWH, there was no difference in baseline characteristics and outcomes of patients treated by stroke- and nonstroke neurologists. CONCLUSION: The case fatality rates were unexpectedly higher at WH than at NWH. If this finding can be reproduced and is not a chance finding, we should identify explanations, especially organisational issues, chronobiological factors or summation of subtle--nonsignificant--baseline differences. Copyright (c) 2010 S. Karger AG, Basel.
BACKGROUND:Stroke outcomes are worse in patients admitted at nonworking hours (NWH), but whether this is also true in patients treated with intravenous (i.v.) thrombolysis has not been definitely proven. OBJECTIVE: Our aim was to test the hypothesis that strokepatients treated by i.v. rt-PA at NWH have a worse outcome than those treated at working hours (WH). METHODS: We compared outcomes at 7 days and at 3 months, between patients treated at NWH and at WH in the stroke unit of the Lille University Hospital. RESULTS: Of 252 consecutive patients [median age: 69 years; 132 men (52.4%); median National Institutes of Health Stroke Scale score: 14; median onset-to-needle time: 150 min], 134 (53.2%) were treated at NWH. They did not differ for baseline characteristics and proportion of patients with modified Rankin Scale scores 0-1 and 0-2 at 3 months. Patients treated at WH were more likely to die before 7 days (12.7 vs. 4.5%; adjusted odds ratio: 3.6; 95% confidence interval: 1.2-10.4) and at 3 months (21.6 vs. 11.4%; adjusted odds ratio: 2.2; 95% confidence interval: 1.02-4.7). The causes of death did not differ between NWH and WH. At NWH, there was no difference in baseline characteristics and outcomes of patients treated by stroke- and nonstroke neurologists. CONCLUSION: The case fatality rates were unexpectedly higher at WH than at NWH. If this finding can be reproduced and is not a chance finding, we should identify explanations, especially organisational issues, chronobiological factors or summation of subtle--nonsignificant--baseline differences. Copyright (c) 2010 S. Karger AG, Basel.
Authors: N Dequatre-Ponchelle; H Touzani; A Banh; I Girard-Buttaz; R Coche; P Dobbelaere; C Cordonnier; M Girot; P Aguettaz; F Mounier-Vehier; E Wiel; N Bronet; E Josien; P Duhamel; M Mihout; A Maisonneuve; A Mackowiak; M Bodenant; P Williatte; X Leclerc; C Lefebvre; O Nigeon; P Devos; G Duncan; G Malanda; B Majed; O Dereeper; V Pégoraro; T Rosolacci; P Alarcon; E Koral; M Pasquini; S Verclytte; J B N'Kuendjo; J B Campagne; P Le Coz; J Devienne; Z Seth; R Tholliez; H Hénon; G Smith; F Dumont; F Agbemebia; J M Behra; D Pollet; P Coffin; P Lavau; A Vérier; C Lucas; N Smaiti; P Dalinval; J Dallongeville; P Valette; J P Pruvo; P Goldstein; D Leys Journal: J Neurol Date: 2014-04-22 Impact factor: 4.849
Authors: Barbara Casolla; Marie Bodenant; Marie Girot; Charlotte Cordonnier; Jean-Pierre Pruvo; Eric Wiel; Didier Leys; Patrick Goldstein Journal: J Neurol Date: 2012-10-10 Impact factor: 4.849