title: Length of stay in emergency department and cerebral intravenous thrombolysis in community hospitals.
abstract: OBJECTIVE
  Current guidelines for the early management of patients with acute ischemic stroke recommend completion of an evaluation within 60 min of the patient's arrival at the emergency department (ED) because prolongation of ED length of stay (LOS) may reduce the efficacy of acute stroke treatment.
  
  
  OBJECTIVE
  To evaluate the LOS in EDs at the community-based Polish stroke centers, to determine logistic, social, epidemiological, and clinical factors responsible for its prolongation, and to assess the association between increased LOS and the implementation of cerebral intravenous (IV) thrombolysis.
  
  
  METHODS
  This study carried out an evaluation of the medical records of 8398 patients with stroke and transient ischemic attack who consecutively reported to the Pomeranian Stroke Registry from 2010 to 2012.
  
  
  RESULTS
  The median ED LOS in the studied cohort was 97 (44-196) min and was prolonged (>60 min) in 63.1% of patients. Prolongation of ED LOS contributed to a low (4.9%) IV thrombolysis rate. Functional status at discharge was worse in patients with prolonged versus nonprolonged LOS [modified Rankin scale: 2 (0-3) vs. 1 (0-3) points; P<0.001]. Multivariate analysis showed that onset-to-door time more than 270 min or unknown time of symptoms onset, referral to ED in urban areas, living alone, presence of diabetes, motor, sensory, visual, and gait deficits at stroke onset, and NIHSS score on admission contributed toward prolongation of ED LOS.
  
  
  CONCLUSIONS
  A prolonged ED LOS, because of ineffective prehospital logistics, ED urban location, patients' risk factors, and cohabitation profile and stroke symptoms and severity, commonly exists among patients with stroke and transient ischemic attack and contributes toward a low rate of IV thrombolysis in Polish community hospitals.
authors.affiliation: aDepartment of Neurology and Stroke Unit, Holy Spirit Specialist Hospital, Sandomierz bDepartment of Neurology, Medical University of Gdańsk, Gdańsk cDepartment of Neurology and Stroke Unit, Saint Luke's Hospital in Końskie, Końskie dClinic of Neurology, Military Medical Institute, Warsaw, Poland eDepartment of Neurology, Ernst-Moritz-Arndt-University, Greifswald, Germany.
authors.forename: Wiktor
authors.initials: W
authors.lastname: Szczuchniak
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Kozera
authors.forename: Piotr
authors.initials: P
authors.lastname: Sobolewski
authors.forename: Waldemar
authors.initials: W
authors.lastname: Brola
authors.forename: Jacek
authors.initials: J
authors.lastname: Staszewski
authors.forename: Ulf
authors.initials: U
authors.lastname: Schminke
authors.forename: Walenty M
authors.initials: WM
authors.lastname: Nyka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D011044:Poland; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D013997:Time Factors