Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
Brain Behav. 2023 May;13(5):e2977. doi: 10.1002/brb3.2977. Epub 2023 Mar 27.
Intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) is a time-dependent treatment with a narrow therapeutic time window, in which the time delay could result from the deadline effect.
One hospital-based cohort was recruited to detect the factors contributing to the deadline effect, where patients with the deadline effect were defined as those who were presented with the onset-to-door time (ODT) in the first 50%, while the door-to-needle time (DNT) was in the last quartile. DNT (in-hospital delay) was further subdivided into several time intervals [door-to-examination time (DET), door-to-imaging time (DIT), door-to-laboratory time (DLT), and decision-making time (DMT) of the patients or their proxies.
A total of 186 IVT cases were enrolled, of which 17.2% (32/186) suffered a delay of the deadline effect. The median age was 66 years, and 35.5% were female. Baseline characteristics were similar between the two groups (all p > .05). For the comparisons of the time intervals, DIT (26 versus 15 min, p = .001) was significantly longer in the group with deadline effect, while the differences of DET, DLT, DMT, and ONT did not reach statistical significance (all p > .05). Upon multivariable adjustment in the binary logistic regression model, longer DIT [odds ratio (OR), 1.076; 95% confidence interval (CI), 1.036-1.118; p < .001], and history of coronary heart disease (OR, 3.898; 95%CI, 1.415-10.735; p = .008) were independently associated with deadline effect in the binary logistic regression model, while admitted in the working day (OR, 0.674; 95%CI, 0.096-0.907; p = .033), and having medical insurance (OR, 0.350; 95% CI, 0.132-0.931; p = .035) were negatively associated with the deadline effect.
A speed-safety tradeoff phenomenon from the deadline effect was observed in 17.2% of IVT cases during the COVID-19 pandemic, where longer DIT contributed a lot to this time delay. Patients without medical insurance, or admitted in official holidays were more likely to experience a delay of the deadline effect.
急性缺血性脑卒中（AIS）的静脉溶栓（IVT）是一种具有时间依赖性的治疗方法，其治疗时间窗很窄，而时间的延迟可能是由于截止日期效应造成的。
我们招募了一个基于医院的队列，以检测导致截止日期效应的因素，其中具有截止日期效应的患者被定义为发病至到院时间（ODT）在前 50%，而门到针时间（DNT）在后四分之一的患者。DNT（院内延误）进一步细分为几个时间间隔[从门到检查时间（DET）、从门到影像时间（DIT）、从门到实验室时间（DLT）和患者或其代理人的决策时间（DMT）]。
共纳入 186 例 IVT 病例，其中 17.2%（32/186）发生了截止日期效应的延误。中位年龄为 66 岁，35.5%为女性。两组间的基线特征相似（均 P>.05）。在时间间隔的比较中，具有截止日期效应组的 DIT（26 分钟比 15 分钟，P=.001）明显延长，而 DET、DLT、DMT 和 ONT 的差异无统计学意义（均 P>.05）。在二元逻辑回归模型的多变量调整后，较长的 DIT[比值比（OR），1.076；95%置信区间（CI），1.036-1.118；P<.001]和冠心病史（OR，3.898；95%CI，1.415-10.735；P=.008）与二元逻辑回归模型中的截止日期效应独立相关，而工作日入院（OR，0.674；95%CI，0.096-0.907；P=.033）和医疗保险（OR，0.350；95%CI，0.132-0.931；P=.035）与截止日期效应呈负相关。
在 COVID-19 大流行期间，IVT 病例中观察到 17.2%的速度-安全权衡现象，即截止日期效应，其中较长的 DIT 对此时间延迟贡献很大。没有医疗保险的患者，或在节假日入院的患者，更有可能出现截止日期效应的延误。
