title: Is there a bad time for intravenous thrombolysis? The experience of Polish stroke centers.
abstract: OBJECTIVE
  The outcome in acute stroke strongly depends on patient-related issues, as well as on the availability of human and diagnostic resources. Our aim was to evaluate safety and effectiveness of intravenous alteplase for stroke according to the time of admission to the hospital.
  
  
  METHODS
  We analyzed the data of all acute stroke patients treated with alteplase between October 2003 and December 2010, contributed to the Safe Implementation of Thrombolysis for Stroke registry from 27 Polish stroke centers. According to the time of admission we distinguished between: (1) non-working days (Friday 14:30-Monday 08:00 plus national holidays); (2) out-of-office hours (non-working days plus 14:30-08:00 during working days); and (3) night hours (time from 23:00 to 06:00). Patients admitted during regular working hours (Monday 08:00-Friday 14:30, excluding national holidays) were used as the reference.
  
  
  RESULTS
  Of 1330 patients, 448 (32.5%) were admitted on non-working days, 868 (65.3%) at out-of-office hours, and 105 (7.9%) during night hours. In multivariate logistic regression, none of the evaluated periods showed association with symptomatic intracranial hemorrhage, 7-day mortality, and neurological improvement ≥4 points in the National Institutes of Health Stroke Scale score at day 7. Patients admitted during night hours had lower odds (OR 0.53, 95% CI: 0.29-0.95, p=0.032) for achieving favorable outcome (modified Rankin Scale score 0-2).
  
  
  CONCLUSIONS
  There is no bad time for thrombolysis. Stroke centers should feel confident about the treatment outside regular working hours, irrespective of equipment and staff availability. However, it may be reasonable to pay additional attention during nighttime.
authors.affiliation: 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Karliński
authors.affiliation: 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland; Interventional Stroke Treatment Centre, Institute of Psychiatry and Neurology, Warsaw, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Kobayashi
authors.affiliation: Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Sobolewski
authors.affiliation: Department of Neurology, University Hospital no. 2, Bydgoszcz, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Lisewski
authors.affiliation: Department of Neurology A, Provincial Specialistic Team Neuropsychiatric, Opole, Poland.
authors.forename: Sławomir
authors.initials: S
authors.lastname: Romanowicz
authors.affiliation: Department of Neurology, Pomeranian Trauma Centre, Gdańsk, Poland.
authors.forename: Waldemar
authors.initials: W
authors.lastname: Fryze
authors.affiliation: Department of Neurology, Medical University of Gdańsk, Gdańsk, Poland.
authors.forename: Walenty
authors.initials: W
authors.lastname: Nyka
authors.affiliation: Department of Neurology, Voivodship Hospital no. 2, Rzeszów, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Zięba
authors.affiliation: Department of Neurology, Central Clinical Hospital of the Ministry of the Interior, Warsaw, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Dorobek
authors.affiliation: 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland. Electronic address: czlonkow@ipin.edu.pl.
authors.forename: Anna
authors.initials: A
authors.lastname: Członkowska
mesh_terms: D000368:Aged; D001071:Appointments and Schedules; D018450:Disease Progression; D023381:Endpoint Determination; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009934:Organization and Administration; D011044:Poland; D012042:Registries; D020521:Stroke / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Alteplase; Ischemic stroke; Outcome; Thrombolysis; Time of admission; Weekends