Time to hospital arrival, use of thrombolytics, and in-hospital outcomes in ischemic stroke.
OBJECTIVE
To determine the interval between symptom onset and hospital arrival and its relationship to baseline clinical characteristics, use of thrombolysis, and in-hospital outcomes in patients with acute ischemic stroke admitted to the 11 hospitals in the Buffalo metropolitan area and Erie County.


METHODS
The medical records of 1,590 patients were reviewed to determine the severity of the neurologic deficits (NIH Stroke Scale [NIHSS]), in-hospital mortality, favorable outcome (modified Rankin Scale score of < or = 2 at discharge), and strata of time interval between symptom onset and hospital arrival.


RESULTS
The time interval between symptom onset and hospital arrival was 0 to 3 hours in 337 (21%) patients, 3 to 6 hours in 177 (11%) patients, 6 to 24 hours in 301 (19%) patients, > 24 hours in 420 (26%) patients, and undetermined in 355 (22%) patients. IV (n = 23) and intra-arterial (n = 4) thrombolysis was used in 27 (8%) of the 337 patients that presented within 3 hours of symptom onset. In 1,235 patients with known time interval between symptom onset and hospital arrival, an association (p = 0.008) was observed between strata of increasing time interval and higher proportion of favorable outcomes at discharge. The initial NIHSS score was higher with decreasing interval between symptom onset and hospital arrival (p < 0.0001).


CONCLUSIONS
A small proportion of patients who present within 3 hours of symptom onset receive thrombolytic therapy. The observation that patients with more severe neurologic deficits and subsequently worse in-hospital outcomes appear to present early after symptom onset to the hospital may have implications for clinical studies.
Zeenat Qureshi Stroke Research Center, Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ, USA. aiqureshi@hotmail.com
A I
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Qureshi
J F
JF
Kirmani
M A
MA
Sayed
A
A
Safdar
S
S
Ahmed
R
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Ferguson
L A
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Hershey
K J
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Qazi
D000208:Acute Disease / Q000401:mortality / Q000451:nursing / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy* / Q000401:mortality* / Q000451:nursing; D004632:Emergency Medical Services / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data / Q000639:trends; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data / Q000639:trends; D010351:Patient Discharge / Q000706:statistics & numerical data / Q000639:trends; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality* / Q000451:nursing; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
D005343:Fibrinolytic Agents