The Weekend Effect Influenced The Time To Thrombolysis For Acute Ischaemic Stroke

Background:According the third retrospective sample survey report of the cause of death in China in2008, the cerebrovascular disease became the first cause of death, replacing the malignant. Ischaemic stroke accounts for60-80%of all cerebrovascular disease. Most guidelines recommend that intravenous recombinant tissue plasminogen activator (rtPA) is the most important reperfusion therapy in the acute phase of ischaemic stroke. It is important to shorten the Onset-to-Treatment Time through the continuous improvement of patient transport and emergency assessment, although expanding the time window of rtPA therapy is the current focus of research. Past studies have focused on the relationship between the time of admission and the percentage of use and the prognosis of intravenous thrombolytic treatment. However, there are less research interested in the relation between the time of admission and the time of Door-to-CT and Door-to-Needle.Object:Our study investigates whether the weekend effect influenced the Door-to-CT Time and the Door-to-Needle Time, and the clinical outcome at discharge.Method:394patients received intravenous thrombolysis from January2003to December2011in Royal Melbourne Hospital in Australia.6(1.5%) patients were excluded as4had received intravenous Desmoteplase,1had received IV-rtPA out of4.5time window and the remaining1had receive IV-rtPA in other hospital and transferred to RMH. Data collected were demographics, time points (stroke symptom onset, presentation to Emergency Department, neuroimaging and thrombolysis) and clinical outcome (modified Rankin Scale (mRS) at discharge and death during admission). For the purpose of the study, we defined Weekend admission according to the current hospital rules in Victory, Australia. Weekend admission was from Friday5:01pm to Monday7:59am. National holiday was from8:00to next day7:59. We compared the Door-to-CT Time, the Door-to-Needle Time, the mRS at discharge and the mortality during admission between the Weekend group and the Weekday group. We compared these end points in the Pre-Code Stroke Era and Code Stroke Era, different TOAST origins, between the severe group and the mild group, and different Onset-to-Door Time by the stratified analysis. Result:Patient data on133in the weekend group and255in the weekday group were collected. There were no significant differences in the gender, age, stroke risk factors, mRS on baseline and National Institute of Health Stroke Scale Score (NIHSS) on baseline. There was a10-minute growth in the median Door-to-Needle Time (80minutes in the Weekend group vs.70minutes in the Weekday group, P=0.003). There were no significant differences in the median Door-to-CT Time (30minutes in the Weekend group vs.25minutes in the Weekday group, P=0.191), the good outcome at discharge (17.8%in the Weekend group vs.18.9%in the Weekday group, P=0.819, OR:0.924,95%CI:0.471-1.815) or the mortality during admission (11.3%in the Weekend group vs.14.1%in the Weekday group, P=0.765, OR:0.895,95%CI:0.432-1.852). Although in the Code Stroke Era, there was a8.5-minute growth in the median Door-to-Needle Time (70.5minutes in the Weekend group vs.62minutes in the Weekday group, P=0.006), the difference reduced by37%compared with the Pre-Code Stroke Era. In the group of cardioembolic origin, there was a6.5-minute growth in the median Door-to-CT Time (29.5minutes in the Weekend group vs.23minutes in the Weekday group,P=0.026) and a13.5-minute growth in the median Door-to-Needle Time (80.5minutes in the Weekend group vs.67minutes in the Weekday group, P=0.009). In the severe group (NIHSS≥10), there was a10-minute growth in the median Door-to-Needle Time (80minutes in the Weekend group vs.70minutes in the Weekday group,P=0.003). In the group that the Onset-to-Door Time less than or equal to90minutes, there was a12.5-minute growth in the median Door-to-Needle Time (86minutes in the Weekend group vs.73.5minutes in the Weekday group,P=0.004).Conclusion:Our study showed that the Weekend Effect increased the Door-to-Needle Time. The Weekend Effect did not influence the Door-to-CT Time and the clinical outcome. The stratified analysis shows that the Weekend Effect increased the Door-to-CT Time in the group of cardioembolic origin and increased the Door-to-Needle Time in the Pre-Code Stroke Era and Code Stroke Era, in the group of cardioembolic origin, in the severe one and in the group of Onset-to-Door Time less than or equal to90minutes.