Sonia Abilleira (Spain)
Institut Catala Salut Healthcare ManagementAuthor Of 1 Presentation
DAY AND NIGHT IN ACUTE STROKE PREHOSPITAL TRIAGE: A POST-HOC ANALYSIS OF THE RACECAT TRIAL
Abstract
Background And Aims
We aim to assess whether time of day modified the treatment effect of the intervention in the RACECAT trial.
Methods
We performed a secondary analysis of RACECAT to evaluate if direct transfer to a thrombectomy-capable center, as compared to transfer to a local stroke center, influence on functional outcome differed according to treatment allocation time: daytime(8:00AM-8:59PM) and nighttime(9:00PM-7:59AM) in patients with ischemic stroke. Primary outcome was modified Rankin score at 90 days.
Results
Of the 1369 patients in the intention to treat population, 949 patients (67%) had an ischemic stroke (mean age 74 ±13 years; 428 women (45.1%); median RACE score 7 (IQR 6 to 8)); 258 of them (27%) were evaluated during nighttime. The odds of better disability outcomes differed according to time of day, favoring direct transfer to a thrombectomy-capable center during nighttime: adjusted common odds ratio (acOR) during daytime, 0.890 (95% confidence interval (CI) 0.680 to 1.163); acOR during nighttime, 1.620 (95% CI 1.020 to 2.551) (pinteraction=0.014). Subgroup analysis revealed a significant heterogeneity in the observed interaction across stroke subtypes; influence of nighttime on the intervention effect was only present in patients with large vessel occlusion: acOR during daytime, 0.766 (95% CI 0.548-1.072); acOR during nighttime, 1.785 (95% CI 1.024 to 3.112) (pinteraction=0.01).
Conclusions
In patients that are evaluated during nighttime for a suspected stroke with high odds of harboring a large vessel occlusion in areas not covered by thrombectomy-capable stroke centers, direct transfer to a thrombectomy-capable center is associated with lower degrees of disability at 3 months.
Trial Registration Number
NCT02795962