Does Time of Day Or Physician Experience Affect Outcome of Acute Ischemic Stroke Patients Treated with Thrombolysis? a Study from Finland

医学 优势比 改良兰金量表 溶栓 脑出血 置信区间 冲程(发动机) 内科学 纤溶剂 逻辑回归 外科 麻醉 组织纤溶酶原激活剂 蛛网膜下腔出血 缺血性中风 缺血 心肌梗塞 工程类 机械工程
作者
Sami Curtze,Atte Meretoja,Satu Mustanoja,Jukka Putaala,Timo Lindberg,Mika Leppä,Marjaana Tiainen,Sari Atula,Turgut Tatlısumak,Markku Kaste
出处
期刊:International Journal of Stroke [SAGE Publishing]
卷期号:7 (6): 511-516 被引量:36
标识
DOI:10.1111/j.1747-4949.2012.00795.x
摘要

Background Maintaining a steady thrombolysis service for treatment of acute ischemic stroke 24 h/7 days is challenging. Diurnal and seasonal variability of stroke onset affects the clinical outcome of these patients. Hypothesis We state that a 24 h/7 days availability of stroke-trained physicians ameliorates weekend effects and other seasonal, weekday, or non-office-hour-related influences on outcome of ischemic stroke patients treated with intravenous thrombolysis. Methods All consecutive ischemic stroke patients treated with thrombolysis at the Helsinki University Central Hospital were prospectively registered ( n = 1581). Patients with basilar artery occlusion ( n = 154) were excluded. Door-to-needle time, three-month clinical outcome as measured by the modified Rankin Scale dichotomized at 0 to 2 vs. 3 to 6, and symptomatic intracerebral hemorrhage were analyzed with logistic regression models adjusting for baseline variables. The treating physician was defined as experienced after 18 decisions made to give thrombolysis treatment. Results Door-to-needle time or clinical outcome did not differ with regard to time of day or season of presentation. Higher rates of symptomatic intracerebral hemorrhage occurred in spring (odds ratio 2.06, 95% confidence interval 1.03–4.11) and fall (odds ratio 2.08, 95% confidence interval 1.03–4.18). Physician experience reduced the door-to-needle time (odds ratio 0.40, 95% confidence interval 0.32–0.50) but was not associated with patient outcome (modified Rankin scale 3 to 6, odds ratio 1.22, 95% confidence interval 0.95–1.59) or symptomatic intracerebral hemorrhage (odds ratio 0.80, 95% confidence interval 0.51–1.27) rates. Conclusions Thrombolytic therapy can be delivered at a steady service level at all times. With proper training, less-experienced physicians can provide high quality thrombolysis, but experience translates into faster treatment.
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