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Intravenous thrombolysis for acute cerebral ischaemia: comparison of outcomes between patients treated at working versus nonworking hours.
MedLine Citation:
PMID:  20551630     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
BACKGROUND: Stroke outcomes are worse in patients admitted at nonworking hours (NWH), but whether this is also true in patients treated with intravenous (i.v.) thrombolysis has not been definitely proven. OBJECTIVE: Our aim was to test the hypothesis that stroke patients treated by i.v. rt-PA at NWH have a worse outcome than those treated at working hours (WH). METHODS: We compared outcomes at 7 days and at 3 months, between patients treated at NWH and at WH in the stroke unit of the Lille University Hospital. RESULTS: Of 252 consecutive patients [median age: 69 years; 132 men (52.4%); median National Institutes of Health Stroke Scale score: 14; median onset-to-needle time: 150 min], 134 (53.2%) were treated at NWH. They did not differ for baseline characteristics and proportion of patients with modified Rankin Scale scores 0-1 and 0-2 at 3 months. Patients treated at WH were more likely to die before 7 days (12.7 vs. 4.5%; adjusted odds ratio: 3.6; 95% confidence interval: 1.2-10.4) and at 3 months (21.6 vs. 11.4%; adjusted odds ratio: 2.2; 95% confidence interval: 1.02-4.7). The causes of death did not differ between NWH and WH. At NWH, there was no difference in baseline characteristics and outcomes of patients treated by stroke- and nonstroke neurologists. CONCLUSION: The case fatality rates were unexpectedly higher at WH than at NWH. If this finding can be reproduced and is not a chance finding, we should identify explanations, especially organisational issues, chronobiological factors or summation of subtle--nonsignificant--baseline differences.
Authors:
Marie Bodenant; Didier Leys; Stéphanie Debette; Charlotte Cordonnier; Frédéric Dumont; Hilde Hénon; Marie Girot; Christian Lucas; David Devos; Luc Defebvre; Dominique Deplanque; Xavier Leclerc; Régis Bordet
Publication Detail:
Type:  Journal Article     Date:  2010-06-10
Journal Detail:
Title:  Cerebrovascular diseases (Basel, Switzerland)     Volume:  30     ISSN:  1421-9786     ISO Abbreviation:  Cerebrovasc. Dis.     Publication Date:  2010  
Date Detail:
Created Date:  2010-07-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9100851     Medline TA:  Cerebrovasc Dis     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  148-56     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2010 S. Karger AG, Basel.
Affiliation:
Department of Neurology, University Hospital of Lille, Lille, France.
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