Nighttime is associated with worse outcome and higher mortality in stroke care, especially in Primary Stroke Centers (PSC). However, studies treating this subject have been inconsistent. Our aim was to investigate whether this negative off-hour-effect also exists for patients being transferred from a PSC to a Comprehensive Stroke Center (CSC) for endovascular treatment (EVT).
From 01/02/2018 to 30/11/2019 consecutive patients who were transferred for EVT within the telestroke network TEMPiS were included and categorized by time of admission in the PSC. Nighttime-hours were defined as from 10pm to 8am. Primary outcome was distribution of modified Rankin Scale (mRS) after 90 days. Secondary outcomes were treatment delays and safety.
Of 266 patients, 84 were admitted during nighttime. The baseline characteristics did not differ significantly between night- and daytime, except for onset-to-door (208 vs. 85min, p=0.0067) and treatment with systemic thrombolysis (37% vs. 52%, p=0.034). There was no difference between groups regarding clinical outcome after 90 days (adjusted common odds for higher mRS during nighttime 0.98, 95%CI 0.58–1.79). Time delays from first door to groin puncture were on average 18 minutes shorter during nighttime (205 vs. 223min, p=0.044). Neither any intracranial hemorrhage (35% vs. 23%, p=0.072) nor mortality after 90 days (31% vs. 31%, p=0.85) differed significantly between groups.
Nighttime admission was not associated with worse clinical outcome or reduced safety in patients being transferred for EVT from a PSC to a CSC. These results support the hypothesis, that quality managed telestroke networks with 24/7 service may prevent a negative off-hour-effect.
not applicable