Impact of Admission Time on Treatment and Outcome of Stroke in Patients Admitted to Tertiary Care Hospital: A Pilot Study from Central India.
BACKGROUND
Admission of patients within window period has been linked with efficacy of treatment outcome and recovery. The present study examined the effects of early vs delayed admission on functional outcome of Acute Ischemic Stroke (AIS) as well as added value of stroke markers in such patients admitted to a tertiary care hospital in Central India.


METHODS
Hundred and four patients admitted to Neurology department of Central India Institute of Medical Sciences were grouped as early referrals (within 24 hour admission) and late referrals (after 24 hour admission) based on onset of symptoms and time of admission. Baseline data, throm bolysis eligibility, hospital and long term outcomes were determined in early and later referrals. Stroke markers NSE, S-100 ββ and ITIH4 peptides were also screened in patients who were further categorized as improved and expired /dependent during hospital outcome. Outcome of death /dependency in both groups was analysed using multivariate regression analysis. Kaplan-Meier analysis was performed to determine the rate of stroke-mortality in hospital and over 12 and 15 month period.


RESULTS
Hospital outcome indicated higher percentage (90%) of improved cases in early referrals as opposed to 79% observed in late referrals. Similarly, the ratio of dependency was slighter higher in late referrals (18%) as compared to early referral (6%) cases. The long term outcome at 12 and 18 months showed more or less similar ratio of death/dependency in early (23%, 9%) and late referrals (32%,24%) respectively. Multivariate analysis revealed no significant impact of risk confounders at long term and short term outcome in both groups. Analysis of stroke marker revealed better prognosis with significant association between ITIH4 peptides and NSE & S-100 ββ level with level of improvement in early referrals.


CONCLUSIONS
Early admission of AIS patients is associated with better hospital outcome. However admission time has no major impact on long term outcome in AIS patients. Moreover, stroke markers such ITIH4, can be used as a predictor of stroke outcome and may have prognostic importance in AIS cases in future.
Research Scientist, Biochemistry Research Centre, Central India Institute of Medical Sciences , Nagpur, Maharashtra, India .
Amit R
AR
Nayak
Senior Research Fellow, Biochemistry Research Centre, Central India Institute of Medical Sciences , Nagpur, Maharashtra, India .
Aliabbas A
AA
Husain
Junior Research Fellow, Biochemistry Research Centre, Central India Institute of Medical Sciences , Nagpur, Maharashtra, India .
Neha H
NH
Lande
Junior Research Fellow, Biochemistry Research Centre, Central India Institute of Medical Sciences , Nagpur, Maharashtra, India .
Anuja P
AP
Kawle
Senior Consultant, Department of Neurology, Central India Institute of Medical Sciences , Nagpur, Maharashtra, India .
Dinesh P
DP
Kabra
Director, Central India Institute of Medical Sciences , Nagpur, Maharashtra, India .
Girdhar M
GM
Taori
Senior Research Consultant, Biochemistry Research Centre, Central India Institute of Medical Sciences , Nagpur, Maharashtra, India .
Hatim F
HF
Daginawala
Senior Scientist, Biochemistry Research Centre, Central India Institute of Medical Sciences , Nagpur, Maharashtra, India .
Rajpal S
RS
Kashyap
Biomarkers; ITIH4 protein; Neuron-specific enolase; Prognosis; Stroke