Ryu Matsuo1, Yuko Yamaguchi1, Tomonaga Matsushita1, Jun Hata1, Fumi Kiyuna1, Kenji Fukuda1, Yoshinobu Wakisaka1, Junya Kuroda1, Tetsuro Ago1, Takanari Kitazono1, Masahiro Kamouchi2. 1. From the Department of Medicine and Clinical Science (R.M., T.M., J.H., F.K., K.F., Y.W., J.K., T.A., T.K.), Department of Health Care Administration and Management (R.M., Y.Y., M.K.), Center for Cohort Study (J.H., Y.W., T.K., M.K.), and Department of Epidemiology and Public Health (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Department of Cerebrovascular Disease, St. Mary's Hospital, Kurume, Japan (T.M., K.F.). 2. From the Department of Medicine and Clinical Science (R.M., T.M., J.H., F.K., K.F., Y.W., J.K., T.A., T.K.), Department of Health Care Administration and Management (R.M., Y.Y., M.K.), Center for Cohort Study (J.H., Y.W., T.K., M.K.), and Department of Epidemiology and Public Health (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; and Department of Cerebrovascular Disease, St. Mary's Hospital, Kurume, Japan (T.M., K.F.). kamouchi@hcam.med.kyushu-u.ac.jp.
Abstract
BACKGROUND AND PURPOSE: The role of early hospital arrival in improving poststroke clinical outcomes in patients without reperfusion treatment remains unclear. This study aimed to determine whether early hospital arrival was associated with favorable outcomes in patients without reperfusion treatment or with minor stroke. METHODS: This multicenter, hospital-based study included 6780 consecutive patients (aged, 69.9±12.2 years; 63.9% men) with ischemic stroke who were prospectively registered in Fukuoka, Japan, between July 2007 and December 2014. Onset-to-door time was categorized as T0-1, ≤1 hour; T1-2, >1 and ≤2 hours; T2-3, >2 and ≤3 hours; T3-6, >3 and ≤6 hours; T6-12, >6 and ≤12 hours; T12-24, >12 and ≤24 hours; and T24-, >24 hours. The main outcomes were neurological improvement (decrease in National Institutes of Health Stroke Scale score of ≥4 during hospitalization or 0 at discharge) and good functional outcome (3-month modified Rankin Scale score of 0-1). Associations between onset-to-door time and main outcomes were evaluated after adjusting for potential confounders using logistic regression analysis. RESULTS: Odds ratios (95% confidence intervals) increased significantly with shorter onset-to-door times within 6 hours, for both neurological improvement (T0-1, 2.79 [2.28-3.42]; T1-2, 2.49 [2.02-3.07]; T2-3, 1.52 [1.21-1.92]; T3-6, 1.72 [1.44-2.05], with reference to T24-) and good functional outcome (T0-1, 2.68 [2.05-3.49], T1-2 2.10 [1.60-2.77], T2-3 1.53 [1.15-2.03], T3-6 1.31 [1.05-1.64], with reference to T24-), even after adjusting for potential confounding factors including reperfusion treatment and basal National Institutes of Health Stroke Scale. These associations were maintained in 6216 patients without reperfusion treatment and in 4793 patients with minor stroke (National Institutes of Health Stroke Scale ≤4 on hospital arrival). CONCLUSIONS: Early hospital arrival within 6 hours after stroke onset is associated with favorable outcomes after ischemic stroke, regardless of reperfusion treatment or stroke severity.
BACKGROUND AND PURPOSE: The role of early hospital arrival in improving poststroke clinical outcomes in patients without reperfusion treatment remains unclear. This study aimed to determine whether early hospital arrival was associated with favorable outcomes in patients without reperfusion treatment or with minor stroke. METHODS: This multicenter, hospital-based study included 6780 consecutive patients (aged, 69.9±12.2 years; 63.9% men) with ischemic stroke who were prospectively registered in Fukuoka, Japan, between July 2007 and December 2014. Onset-to-door time was categorized as T0-1, ≤1 hour; T1-2, >1 and ≤2 hours; T2-3, >2 and ≤3 hours; T3-6, >3 and ≤6 hours; T6-12, >6 and ≤12 hours; T12-24, >12 and ≤24 hours; and T24-, >24 hours. The main outcomes were neurological improvement (decrease in National Institutes of Health Stroke Scale score of ≥4 during hospitalization or 0 at discharge) and good functional outcome (3-month modified Rankin Scale score of 0-1). Associations between onset-to-door time and main outcomes were evaluated after adjusting for potential confounders using logistic regression analysis. RESULTS: Odds ratios (95% confidence intervals) increased significantly with shorter onset-to-door times within 6 hours, for both neurological improvement (T0-1, 2.79 [2.28-3.42]; T1-2, 2.49 [2.02-3.07]; T2-3, 1.52 [1.21-1.92]; T3-6, 1.72 [1.44-2.05], with reference to T24-) and good functional outcome (T0-1, 2.68 [2.05-3.49], T1-2 2.10 [1.60-2.77], T2-3 1.53 [1.15-2.03], T3-6 1.31 [1.05-1.64], with reference to T24-), even after adjusting for potential confounding factors including reperfusion treatment and basal National Institutes of Health Stroke Scale. These associations were maintained in 6216 patients without reperfusion treatment and in 4793 patients with minor stroke (National Institutes of Health Stroke Scale ≤4 on hospital arrival). CONCLUSIONS: Early hospital arrival within 6 hours after stroke onset is associated with favorable outcomes after ischemic stroke, regardless of reperfusion treatment or stroke severity.
Authors: Nuria P Torres-Aguila; Caty Carrera; Elena Muiño; Natalia Cullell; Jara Cárcel-Márquez; Cristina Gallego-Fabrega; Jonathan González-Sánchez; Alejandro Bustamante; Pilar Delgado; Laura Ibañez; Laura Heitsch; Jerzy Krupinski; Joan Montaner; Joan Martí-Fàbregas; Carlos Cruchaga; Jin-Moo Lee; Israel Fernandez-Cadenas Journal: J Stroke Date: 2019-09-30 Impact factor: 6.967