Altersberger Valerian L, Wright Patrick R, Schaedelin Sabine A, De Marchis Gian Marco, Gensicke Henrik, Engelter Stefan T, Psychogios Marios, Kahles Timo, Goeldlin Martina, Meinel Thomas R, Mordasini Pasquale, Kaesmacher Johannes, von Hessling Alexander, Vehoff Jochen, Weber Johannes, Wegener Susanne, Salmen Stephan, Sturzenegger Rolf, Medlin Friedrich, Berger Christian, Schelosky Ludwig, Renaud Susanne, Niederhauser Julien, Bonvin Christophe, Schaerer Michael, Mono Marie-Luise, Rodic Biljana, Schwegler Guido, Peters Nils, Bolognese Manuel, Luft Andreas R, Cereda Carlo W, Kägi Georg, Michel Patrick, Carrera Emmanuel, Arnold Marcel, Fischer Urs, Nedeltchev Krassen, Bonati Leo H
Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland.
Clinical Trial Unit, University Hospital Basel and University of Basel, Basel, Switzerland.
Eur Stroke J. 2022 Jun;7(2):117-125. doi: 10.1177/23969873221094408. Epub 2022 Apr 27.
Rapid treatment of acute ischemic stroke (AIS) depends on sufficient staffing which differs between Stroke Centers and Stroke Units in Switzerland. We studied the effect of admission time on performance measures of AIS treatment and related temporal trends over time.
We compared treatment rates, door-to-image-time, door-to-needle-time, and door-to-groin-puncture-time in stroke patients admitted during office hours (Monday-Friday 8:00-17:59) and non-office hours at all certified Stroke Centers and Stroke Units in Switzerland, as well as secular trends thereof between 2014 and 2019, using data from the Swiss Stroke Registry. Secondary outcomes were modified Rankin Scale and mortality at 3 months.
Data were eligible for analysis in 31,788 (90.2%) of 35,261 patients. Treatment rates for IVT/EVT were higher during non-office hours compared with office hours in Stroke Centers (40.8 vs 36.5%) and Stroke Units (21.8 vs 18.5%). Door-to-image-time and door-to-needle-time increased significantly during non-office hours. Median (IQR) door-to-groin-puncture-time at Stroke Centers was longer during non-office hours compared to office hours (84 (59-116) vs 95 (66-130) minutes). Admission during non-office hours was independently associated with worse functional outcome (1.11 [95%CI: 1.04-1.18]) and increased mortality (1.13 [95%CI: 1.01-1.27]). From 2014 to 2019, median door-to-groin-puncture-time improved and the treatment rate for wake-up strokes increased.
Despite differences in staffing, patient admission during non-office hours delayed IVT to a similar, modest degree at Stroke Centers and Stroke Units. A larger delay of EVT was observed during non-office hours, but Stroke Centers sped up delivery of EVT over time. Patients admitted during non-office hours had worse functional outcomes, which was not explained by treatment delays.
急性缺血性卒中（AIS）的快速治疗取决于充足的人员配备，而瑞士的卒中中心和卒中单元在这方面存在差异。我们研究了入院时间对AIS治疗性能指标及相关时间趋势的影响。
我们利用瑞士卒中登记处的数据，比较了瑞士所有认证的卒中中心和卒中单元在办公时间（周一至周五8:00 - 17:59）和非办公时间收治的卒中患者的治疗率、门到影像时间、门到针时间和门到股动脉穿刺时间，以及2014年至2019年期间的长期趋势。次要结局为改良Rankin量表评分和3个月时的死亡率。
35261例患者中有31788例（90.2%）的数据符合分析条件。在卒中中心，非办公时间的静脉溶栓/血管内治疗（IVT/EVT）治疗率高于办公时间（40.8%对36.5%）；在卒中单元，非办公时间的治疗率也高于办公时间（21.8%对18.5%）。非办公时间的门到影像时间和门到针时间显著增加。卒中中心非办公时间的门到股动脉穿刺时间中位数（四分位间距）比办公时间长（84（59 - 116）分钟对95（66 - 130）分钟）。非办公时间入院与更差的功能结局（1.11 [95%置信区间：1.04 - 1.18]）和更高的死亡率（1.13 [95%置信区间：1.01 - 1.27]）独立相关。从2014年到2019年，门到股动脉穿刺时间中位数有所改善，醒后卒中的治疗率有所提高。
尽管人员配备存在差异，但在卒中中心和卒中单元，非办公时间收治的患者静脉溶栓延迟程度相似且较小。非办公时间血管内治疗延迟更大，但随着时间推移，卒中中心加快了血管内治疗的实施。非办公时间入院的患者功能结局更差，这不能用治疗延迟来解释。
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