title: Impact of Day of the Week and Time of Arrival on Ischemic Stroke Management.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the association between measures of patient arrival day (weekday or weekend day), day part (nighttime vs. daytime) and hour (regular hours vs. off hours) at the stroke unit of the Emergency Department of the Puerto Rico Medical Center and the following time-to-treatment measures: door-to-CT-scan, door-to-needle, and stroke-onset-to-treatment.
  
  
  METHODS
  In this retrospective study, the data of 54 patients was obtained from the stroke unit of the Puerto Rico Medical Center through the Get With The Guidelines- Stroke Registry. Inclusion criteria were as follows: having an ischemic stroke within the period covering from August 2008 through February 2010 and being at least 18 years old. Associations between patient arrival time and timeliness of interventions were assessed using t-tests/Mann-Whitney tests and chi-square tests/Fisher's exact tests, as appropriate.
  
  
  RESULTS
  The majority of the patients (74%) were men. The mean and standard deviation of age was 67±14 years. The median of times for door-to-CT-scan and onset to treatment were 15 minutes (interquartile range=15) and 2.7 hours (interquartile range=0.6), respectively. The mean and standard deviation for door-to-needle time was 77±18 minutes. No differences were found for any of the variables in terms of arrival date, day part or hour (p>0.05). The median time for door-to-CT- scan was shorter for patients receiving intravenous tissue plasminogen activator treatment than it was for those not receiving such treatment (12 minutes vs. 20 minutes; p=0.02).
  
  
  CONCLUSIONS
  The timeliness of the stroke management interventions did not differ significantly in terms of arrival day, day part, or hour.
authors.affiliation: Section of Neurosurgery, Department of Surgery, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR.
authors.forename: Ingrid V
authors.initials: IV
authors.lastname: Rodríguez-Rivera
authors.affiliation: Department of Neurology, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR.
authors.forename: Fernando
authors.initials: F
authors.lastname: Santiago
authors.affiliation: Graduate Department, School of Health Professions, University of Puerto Rico Medical Sciences Campus, San Juan, PR.
authors.forename: Estela S
authors.initials: ES
authors.lastname: Estapé
authors.affiliation: Puerto Rico Clinical and Translational Research Consortium, University of Puerto Rico Medical Sciences Campus, San Juan, PR.
authors.forename: Lorena
authors.initials: L
authors.lastname: González-Sepúlveda
authors.affiliation: Section of Neurosurgery, Department of Surgery, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Brau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D011647:Puerto Rico; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D020521:Stroke / Q000628:therapy*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Acute Ischemic Stroke Management; Door to Needle; Intravenous Thrombolytic Treatment; Ischemic Brain Disease; Weekend Effect