Evidence map›Paper›PMID 32737653›Full record

Observational studyJournal of neurology2021

Presentation outside office hours does not negatively influence treatment times for reperfusion therapy for acute ischemic stroke.

A E Groot, H de Bruin, T T M Nguyen, M Kappelhof, F de Beer, M C Visser, C P Zwetsloot, P H A Halkes, J de Kruijk, W D M van der Meulen and 12 more

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Journal of neurology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Article
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

22 authors.

A E GrootNeurology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
H de BruinNeurology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
T T M NguyenNeurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
M KappelhofRadiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
F de BeerNeurology, Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC, Haarlem, The Netherlands.
M C VisserNeurology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Boelelaan 1117-1118, 1081 HV, Amsterdam, The Netherlands.
C P ZwetslootNeurology, Dijklander, Waterlandlaan 250, 1441 RN, Purmerend, The Netherlands.
P H A HalkesNeurology, Noord-West Ziekenhuisgroep, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands.
J de KruijkNeurology, Tergooi, Van Linschotenlaan 35, 1212 DR, Hilversum, The Netherlands.
W D M van der MeulenNeurology, Rode Kruis, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands.
T C van der ReeNeurology, Dijklander, Maelsonstraat 3, 1624 NP, Hoorn, The Netherlands.
V I H KwaNeurology, OLVG-Oost, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands.
S M van SchaikNeurology, OLVG-West, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
L HaniNeurology, Noord-West Ziekenhuisgroep, Huisduinerweg 3, 1782 GZ, Den Helder, The Netherlands.
R van den BergRadiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
M E S SprengersRadiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
S D RoosendaalRadiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
B J EmmerRadiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
P J NederkoornNeurology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
C B L M MajoieRadiology and Nuclear Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Y B W E M RoosNeurology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
J M CoutinhoNeurology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. j.coutinho@amsterdamumc.nl.ORCID http://orcid.org/0000-0002-8284-982X

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTreatment outside office hours has been associated with increased workflow times for intravenous thrombolysis (IVT) in acute ischemic stroke (AIS). Limited data suggest that this "off-hours effect" also exists for endovascular treatment (EVT). We investigated this phenomenon in a well-organized acute stroke care region in the Netherlands.

methodsRetrospective, observational cohort study of consecutive patients with AIS who received reperfusion therapy in the Greater Amsterdam Area, consisting of 14 primary stroke centers and 1 comprehensive stroke center (IVT: 2009-2015, EVT: 2014-2017). Office hours were defined as presentation during weekdays between 8 AM and 5 PM, excluding National Festive days. Primary outcome was door-to-treatment time (door-to-needle [DNT] for IVT, door-to-groin [DGT] for EVT). For DGT, we used the door time of the first hospital. Other outcomes were in-hospital mortality, modified Rankin Scale (mRS) score at 90 days and symptomatic intracranial hemorrhage (sICH). We performed multivariable linear and logistic regression analyses and used multiple imputation to account for missing values.

resultsIn total, 59% (2450/4161) and 61% (239/395) of patients treated with IVT and EVT, respectively, presented outside office hours. Median DNT was minimally longer outside office hours (32 vs. 30 min, p = 0.024, adjusted difference 2.5 min, 95% CI 0.7-4.2). Presentation outside office hours was not associated with a longer DGT (median 130 min for both groups, adjusted difference 7.0 min, 95% CI - 4.2 to 18.1). Clinical outcome and sICH rate also did not differ.

conclusionPresentation outside office hours did not lead to clinically relevant treatment delays for reperfusion therapy in patients with AIS.

Indexed as

Brain IschemiaEndovascular ProceduresIschemic StrokeStrokeHumansNetherlandsReperfusionRetrospective StudiesThrombolytic TherapyTime FactorsTreatment OutcomeAcute ischemic strokeFunctional outcomeOff-hour presentationTreatment timesWorkflow

Identifiers

PMID32737653
PMCPMC7815598

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.