Early hospital arrival improves outcome at discharge in ischemic but not hemorrhagic stroke: a prospective multicenter study.
BACKGROUND
Our purpose was to determine whether the onset-to-arrival time affects the outcome of stroke patients.


METHODS
We carried out a prospective multicenter study involving 1,817 patients with ischemic stroke and 1,226 with intracerebral hemorrhage who presented to hospitals within 24 h of symptom onset. The primary outcome was independent activity of daily living corresponding to a modified Rankin Scale (mRS) score <or=2 at discharge approximately 3 weeks after stroke.


RESULTS
In ischemic stroke patients, the initial NIH Stroke Scale (NIHSS) score decreased as the onset-to-arrival time increased: 9 (median) in the earliest tertile group (<3 h), 5 in the second tertile group (3-8 h) and 4 in the latest tertile group (>or=8 h, p < 0.001). The median mRS scores at discharge in these groups were 3, 2 and 2, respectively (p < 0.001). After adjustment for underlying features and the initial NIHSS score, the independent activity of daily living at discharge was 1.73 times more common in patients in the earliest group than in the latest group (95% CI = 1.24-2.42, p = 0.001). A similar tendency was shown in the subanalysis for large-artery atherosclerosis and cardioembolic stroke. In intracerebral hemorrhage patients, both the initial NIHSS score and the mRS score at discharge decreased as the onset-to-arrival time increased. After multivariate adjustment, the independent activity of daily living was 2.33 times (p < 0.001) and 1.69 times (p = 0.006) less common in patients in the earliest (<1.2 h) and second tertile groups (1.2-3.5 h), respectively, than in the latest tertile group (>or=3.5 h).


CONCLUSIONS
Early hospital arrival improved the clinical outcome in ischemic stroke patients but not in patients with intracerebral hemorrhage.
Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Suita, Japan.
Masaki
M
Naganuma
Kazunori
K
Toyoda
Hiroshi
H
Nonogi
Chiaki
C
Yokota
Masatoshi
M
Koga
Hiroyuki
H
Yokoyama
Akira
A
Okayama
Hiroaki
H
Naritomi
Kazuo
K
Minematsu
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis* / Q000188:drug therapy; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000188:drug therapy; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator