Department of Neurosciences, University of California, San Diego, CA 92103, USA.
Int J Stroke. 2012 Aug;7(6):473-6. doi: 10.1111/j.1747-4949.2011.00610.x. Epub 2011 Jun 30.
There is diurnal variation for cardiac arrest and sudden cardiac death. Stroke may show a similar pattern. We assessed whether strokes presenting during a particular time of day or night are more likely of vascular etiology.
To compare emergency department stroke codes arriving between 22:00 and 8:00 hours (LuNAR strokes) vs. others (n-LuNAR strokes). The purpose was to determine if late night strokes are more likely to be true strokes or warrant acute tissue plasminogen activator evaluations.
We reviewed prospectively collected cases in the University of California, San Diego Stroke Team database gathered over a four-year period. Stroke codes at six emergency departments were classified based on arrival time. Those arriving between 22:00 and 8:00 hours were classified as LuNAR stroke codes, the remainder were classified as 'n-LuNAR'. Patients were further classified as intracerebral hemorrhage, acute ischemic stroke not receiving tissue plasminogen activator, acute ischemic stroke receiving tissue plasminogen activator, transient ischemic attack, and nonstroke. Categorical outcomes were compared using Fisher's Exact test. Continuous outcomes were compared using Wilcoxon's Rank-sum test.
A total of 1607 patients were included in our study, of which, 299 (19%) were LuNAR code strokes. The overall median NIHSS was five, higher in the LuNAR group (n-LuNAR 5, LuNAR 7; P=0·022). There was no overall differences in patient diagnoses between LuNAR and n-LuNAR strokes (P=0·169) or diagnosis of acute ischemic stroke receiving tissue plasminogen activator (n-LuNAR 191 (14·6%), LuNAR 42 (14·0%); P=0·86). Mean arrival to computed tomography scan time was longer during LuNAR hours (n-LuNAR 54·9±76·3 min, LuNAR 62·5±87·7 min; P=0·027). There was no significant difference in 90-day mortality (n-LuNAR 15·0%, LuNAR 13·2%; P=0·45).
Our stroke center experience showed no difference in diagnosis of acute ischemic stroke between day and night stroke codes. This similarity was further supported in similar rates of tissue plasminogen activator administration. Late night strokes may warrant a more rapid stroke specialist evaluation due to the longer time elapsed from symptom onset and the longer time to computed tomography scan.
心脏骤停和心源性猝死存在昼夜变化。中风可能也存在类似的模式。我们评估了在一天中的特定时间或夜间出现的中风是否更有可能是血管性病因。
比较夜间 22:00 至 8:00 时段（夜间中风）与其他时段（非夜间中风）到达急诊室的中风代码。目的是确定深夜中风是否更有可能是真正的中风，还是需要进行急性组织型纤溶酶原激活剂评估。
我们回顾了在加利福尼亚大学圣地亚哥卒中团队数据库中收集的为期四年的前瞻性病例。根据到达时间，对六个急诊室的中风代码进行分类。夜间 22:00 至 8:00 时段到达的被归类为夜间中风代码，其余的被归类为非夜间中风代码。患者进一步分为脑出血、未接受组织型纤溶酶原激活剂治疗的急性缺血性中风、接受组织型纤溶酶原激活剂治疗的急性缺血性中风、短暂性脑缺血发作和非中风。使用 Fisher 精确检验比较分类结果。使用 Wilcoxon 秩和检验比较连续结果。
共有 1607 名患者纳入我们的研究，其中 299 名（19%）为夜间中风代码患者。总的 NIHSS 中位数为 5，夜间中风组更高（非夜间中风 5，夜间中风 7；P=0·022）。夜间中风和非夜间中风之间的患者诊断总体上没有差异（P=0·169），也没有接受组织型纤溶酶原激活剂治疗的急性缺血性中风诊断差异（非夜间中风 191 例（14.6%），夜间中风 42 例（14.0%）；P=0·86）。夜间中风时到达计算机断层扫描的平均时间更长（非夜间中风 54.9±76.3 分钟，夜间中风 62.5±87.7 分钟；P=0·027）。90 天死亡率无显著差异（非夜间中风 15.0%，夜间中风 13.2%；P=0·45）。
我们的卒中中心经验表明，白天和夜间卒中代码之间的急性缺血性卒中诊断没有差异。这种相似性进一步得到了接受组织型纤溶酶原激活剂治疗率相似的支持。由于从症状发作到计算机断层扫描的时间延长，深夜中风可能需要更快速的卒中专家评估。
