title: Association of time on outcome after intravenous thrombolysis in the elderly in a telestroke network.
abstract: BACKGROUND
  Recent studies showed that the safety and benefit of early intravenous (IV) thrombolysis on favourable outcomes in acute ischemic stroke are also seen in the elderly. Furthermore, it has shown that age increases times for pre- and in-hospital procedures. We aimed to assess the applicability of these findings to telestroke.
  
  
  METHODS
  We retrospectively analysed 542 of 1659 screened consecutive stroke patients treated with IV thrombolysis in our telestroke network in East-Saxony, Germany from 2007 to 2012. Outcome data were symptomatic intracranial hemorrhage (sICH) by ECASS-2-criteria, survival at discharge and favourable outcome, defined as a modified Rankin scale (mRS) of 0-2 at discharge.
  
  
  RESULTS
  Thirty-three percent of patients were older than 80 years (elderly). Being elderly was associated with higher risk of sICH (p = 0.003), less favourable outcomes (p = 0.02) and higher mortality (p = 0.01). Using logistic regression analysis, earlier onset-to-treatment time was associated with favourable outcomes in not elderly patients (adjusted odds ratio (OR) 1.18; 95% CI 1.03-1.34; p = 0.01), and tended to be associated with favourable outcomes (adjusted OR 1.13; 95% CI 0.92-1.38; p = 0.25) and less sICH (adjusted OR 0.88; 95% CI 0.76-1.03; p = 0.11) in elderly patients. Age caused no significant differences in onset-to-door-time (p = 0.25), door-to-treatment-time (p = 0.06) or onset-to-treatment-time (p = 0.29).
  
  
  CONCLUSIONS
  Treatment time seems to be critical for favourable outcome after acute ischemic stroke in the elderly. Age is not associated with longer delivery times for thrombolysis in telestroke.
authors.affiliation: Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany Charlotte.Zerna@uniklinikum-dresden.de.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Zerna
authors.affiliation: Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany.
authors.forename: Timo
authors.initials: T
authors.lastname: Siepmann
authors.affiliation: Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany.
authors.forename: Kristian
authors.initials: K
authors.lastname: Barlinn
authors.affiliation: Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany.
authors.forename: Jessica
authors.initials: J
authors.lastname: Kepplinger
authors.affiliation: Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany.
authors.forename: Lars-Peder
authors.initials: LP
authors.lastname: Pallesen
authors.affiliation: Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Puetz
authors.affiliation: Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Bodechtel
mesh_terms: D061605:Administration, Intravenous; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005858:Germany; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy*; D016019:Survival Analysis; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors
chemical_list: D005343:Fibrinolytic Agents
keywords: Telemedicine; acute stroke therapy; epidemiology; ischemic stroke; stroke facilities; thrombolysis