title: Direct access to a hospital offering intravenous thrombolysis therapy improves functional outcome of acute ischemic stroke patients.
abstract: Referral from other hospitals is one of the primary causes of delayed thrombolysis therapy after acute ischemic stroke (AIS). We aimed to evaluate whether direct access to a hospital offering intravenous thrombolysis therapy was associated with good functional outcome in AIS patients treated with thrombolysis. We enrolled patients who received intravenous thrombolysis within 3 hours of symptom onset at our stroke center. We divided these patients into two groups: those with a direct admission to our stroke center and those with indirect admission by referral from other community hospitals. We investigated onset-to-door time and onset-to-recombinant tissue plasminogen activator (rtPA) time according to admission mode. We then assessed the association between a direct admission and favorable outcome at 90 days. A total of 232 patients (mean age of 66.6 years, median National Institutes of Health Stroke Scale score of 10) were included. A total of 48.7% of AIS patients treated with intravenous thrombolytic therapy were transferred from other hospitals. Patients who were directly admitted to our stroke center had a shorter onset-to-door time (61 versus 120 minutes, p<0.001) and onset-to-rtPA time (103 versus 155 minutes, p<0.001) than those referred from other hospitals. Direct admission was associated with a good outcome with an odds ratio of 2.03 (95% confidence interval 1.051-3.917, p=0.035), after adjusting for baseline variables. Thrombolysis after direct admission to a hospital offering intravenous thrombolysis therapy could shorten onset-to-rtPA time and improve stroke outcome in patients with AIS.
authors: Department of Neurology, College of Medicine, Dong-A University, 1, 3-ga Dongdaesin-dong, Seo-gu, Busan 602-715, Republic of Korea; Busan-Ulsan Regional Cardiocerebrovascular Center, Busan, Republic of Korea.
authors: Dae-Hyun
authors: DH
authors: Kim
authors: Department of Neurology, College of Medicine, Dong-A University, 1, 3-ga Dongdaesin-dong, Seo-gu, Busan 602-715, Republic of Korea; Busan-Ulsan Regional Cardiocerebrovascular Center, Busan, Republic of Korea. Electronic address: nrcjk65@gmail.com.
authors: Jae-Kwan
authors: JK
authors: Cha
authors: Busan-Ulsan Regional Cardiocerebrovascular Center, Busan, Republic of Korea.
authors: Hyun-Seok
authors: HS
authors: Park
authors: Busan-Ulsan Regional Cardiocerebrovascular Center, Busan, Republic of Korea.
authors: Jae-Hyung
authors: JH
authors: Choi
authors: Busan-Ulsan Regional Cardiocerebrovascular Center, Busan, Republic of Korea.
authors: Myung-Jin
authors: MJ
authors: Kang
authors: Busan-Ulsan Regional Cardiocerebrovascular Center, Busan, Republic of Korea.
authors: Jae-Taeck
authors: JT
authors: Huh
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D002545:Brain Ischemia / Q000628:therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006297:Health Services Accessibility; D006761:Hospitals; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010343:Patient Admission; D011446:Prospective Studies; D012042:Registries; D012720:Severity of Illness Index; D020521:Stroke / Q000628:therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Acute ischemic stroke; Admission route; Interhospital transfer; Intravenous thrombolysis