Direct admission to stroke centers reduces treatment delay and improves clinical outcome after intravenous thrombolysis

Dae Hyun Kim, Hee Joon Bae, Moon Ku Han, Beom Joon Kim, Sang Soon Park, Tai Hwan Park, Kyung Bok Lee, Kyusik Kang, Jong Moo Park, Youngchai Ko, Soo Joo Lee, Jay Chol Choi, Joon Tae Kim, Ki Hyun Cho, Keun Sik Hong, Yong Jin Cho, Dong Eog Kim, Jun Lee, Juneyoung Lee, Mi Sun OhKyung Ho Yu, Byung Chul Lee, Hyun Wook Nah, Jae Kwan Cha

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

We aimed to examine whether direct access to hospitals offering intravenous thrombolysis is associated with functional outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis. We enrolled patients who received intravenous thrombolysis within 4.5 hours of symptom onset using a prospective multicenter registry database. Patients referred directly from the field to organized stroke centers were compared with those who were transferred from non-thrombolysis-capable hospitals in terms of clinical outcomes at 90 days after intravenous recombinant tissue plasminogen activator treatment. We also investigated onset-to-door time and onset-to-needle time according to admission mode. A total of 820 patients (mean age of 67.3 years and median National Institutes of Health Stroke Scale score of 9) were enrolled. Seventeen percent of patients with AIS who received intravenous thrombolytic therapy at 12 hospitals (n = 142) were transferred from other hospitals. The direct admission group had a shorter median onset-to-admission time (63 versus 121 minutes, P < 0.001) and onset-to-needle time (110 versus 161 minutes, P < 0.001) as compared with the indirect admission group. Direct admission was associated with a good outcome with an odds ratio of 1.57 (95% confidence interval: 1.02-2.39, P = 0.036) after adjustment for baseline variables. Direct admission to a hospital with intravenous thrombolysis facilities available at all times was associated with shorter onset-to-needle time and better outcome in patients with AIS undergoing thrombolytic therapy. Our findings support the implementation of regional stroke care programs transporting patients directly to stroke centers to promote faster treatment and to achieve better outcomes.

Original languageEnglish
Pages (from-to)74-79
Number of pages6
JournalJournal of Clinical Neuroscience
Volume27
DOIs
Publication statusPublished - 2016 May 1

Keywords

  • Acute ischemic stroke
  • Admission route
  • Interhospital transfer
  • Intravenous thrombolysis

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Physiology (medical)

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    Kim, D. H., Bae, H. J., Han, M. K., Kim, B. J., Park, S. S., Park, T. H., Lee, K. B., Kang, K., Park, J. M., Ko, Y., Lee, S. J., Choi, J. C., Kim, J. T., Cho, K. H., Hong, K. S., Cho, Y. J., Kim, D. E., Lee, J., Lee, J., ... Cha, J. K. (2016). Direct admission to stroke centers reduces treatment delay and improves clinical outcome after intravenous thrombolysis. Journal of Clinical Neuroscience, 27, 74-79. https://doi.org/10.1016/j.jocn.2015.06.038