Workflow Intervals of Endovascular Acute Stroke Therapy During On- Versus Off-Hours: The MR CLEAN Registry

Wouter H Hinsenveld; Inger R de Ridder; Robert J van Oostenbrugge; Jan A Vos; Adrien E Groot; Jonathan M Coutinho; Geert J Lycklama À Nijeholt; Jelis Boiten; Wouter J Schonewille; MR CLEAN Registry Investigators

doi:10.1161/STROKEAHA.119.025381

Workflow Intervals of Endovascular Acute Stroke Therapy During On- Versus Off-Hours: The MR CLEAN Registry

Stroke. 2019 Oct;50(10):2842-2850. doi: 10.1161/STROKEAHA.119.025381. Epub 2019 Aug 7.

Authors

Wouter H Hinsenveld¹, Inger R de Ridder¹, Robert J van Oostenbrugge¹, Jan A Vos², Adrien E Groot³, Jonathan M Coutinho³, Geert J Lycklama À Nijeholt⁴, Jelis Boiten⁴, Wouter J Schonewille⁵; MR CLEAN Registry Investigators

Collaborators

MR CLEAN Registry Investigators:
Diederik W J Dippel, Aad van der Lugt, Charles B L M Majoie, Yvo B W E M Roos, Wim H van Zwam, Ivo G H Jansen, Maxim J H L Mulder, Robert-Jan B Goldhoorn, Kars C J Compagne, Manon Kappelhof, Charles B L M Majoie, Marieke J H Wermer, Marianne A A van Walderveen, Julie Staals, Wim H van Zwam, Jeannette Hofmeijer, Jasper M Martens, Bob Roozenbeek, Bart J Emmer, Sebastiaan F de Bruijn, Lukas C van Dijk, H Bart van der Worp, Rob H Lo, Ewoud J van Dijk, Hieronymus D Boogaarts, Paul L M de Kort, Jo J P Peluso, Jan S P van den Berg, Boudewijn A A M van Hasselt, Leo A M Aerden, René J Dallinga, Maarten Uyttenboogaart, Omid Eshghi, Tobien H C M L Schreuder, Roel J J Heijboer, Koos Keizer, Lonneke S F Yo, Heleen M den Hertog, Emiel J C Sturm, Charles B L M Majoie, Wim H van Zwam, Aad van der Lugt, Marianne A A van Walderveen, Marieke E S Sprengers, Sjoerd F M Jenniskens, René van den Berg, Albert J Yoo, Ludo F M Beenen, Alida A Postma, Stefan D Roosendaal, Bas F W van der Kallen, Ido R van den Wijngaard, Adriaan C G M van Es, Bart J Emmer, Jasper M Martens, Lonneke S F Yo, Joost Bot, Pieter-Jan van Doormaal, Diederik W J Dippel, Aad van der Lugt, Charles B L M Majoie, Yvo B W E M Roos, Wim H van Zwam, Jeannette Hofmeijer, Jasper M Martens, H Bart van der Worp, Rob H Lo, Jeannette Hofmeijer, H Zwenneke Flach, Hester F Lingsma, Naziha El Ghannouti, Martin Sterrenberg, Corina Puppels, Wilma Pellikaan, Rita Sprengers, Marjan Elfrink, Joke de Meris, Tamara Vermeulen, Annet Geerlings, Gina van Vemde, Tiny Simons, Cathelijn van Rijswijk, Gert Messchendorp, Hester Bongenaar, Karin Bodde, Sandra Kleijn, Jasmijn Lodico, Hanneke Droste, M Wollaert, D Jeurrissen, Ernas Bos, Yvonne Drabbe, Nicoline Aaldering, Berber Zweedijk, Mostafa Khalilzada, Esmee Venema, Vicky Chalos, Ralph R Geuskens, Tim van Straaten, Saliha Ergezen, Roger R M Harmsma, Daan Muijres, Anouk de Jong, Olvert A Berkhemer, Anna M M Boersc, J Huguet, P F C Groot, Marieke A Mens, Katinka R van Kranendonk, Kilian M Treurniet, Manon L Tolhuijsen, Heitor Alves

Affiliations

¹ From the Department of Neurology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands (W.H.H., I.R.d.R., R.J.v.O.).
² Department of Radiology (J.A.V.), St. Antonius Hospital, Nieuwegein, the Netherlands.
³ Department of Neurology, Amsterdam UMC, University of Amsterdam, the Netherlands (A.E.G., J.M.C.).
⁴ Department of Neurology and Radiology, Haaglanden Medical Center, The Hague, the Netherlands (G.J.L.à.N., J.B.).
⁵ Department of Neurology (W.J.S.), St. Antonius Hospital, Nieuwegein, the Netherlands.

PMID: 31869287
DOI: 10.1161/STROKEAHA.119.025381

Abstract

Background and Purpose- Endovascular treatment (EVT) of patients with acute ischemic stroke because of large vessel occlusion involves complicated logistics, which may cause a delay in treatment initiation during off-hours. This might lead to a worse functional outcome. We compared workflow intervals between endovascular treatment-treated patients presenting during off- and on-hours. Methods- We retrospectively analyzed data from the MR CLEAN Registry, a prospective, multicenter, observational study in the Netherlands and included patients with an anterior circulation large vessel occlusion who presented between March 2014 and June 2016. Off-hours were defined as presentation on Monday to Friday between 17:00 and 08:00 hours, weekends (Friday 17:00 to Monday 8:00) and national holidays. Primary end point was first door to groin time. Secondary end points were functional outcome at 90 days (modified Rankin Scale) and workflow time intervals. We stratified for transfer status, adjusted for prognostic factors, and used linear and ordinal regression models. Results- We included 1488 patients of which 936 (62.9%) presented during off-hours. Median first door to groin time was 140 minutes (95% CI, 110-182) during off-hours and 121 minutes (95% CI, 85-157) during on-hours. Adjusted first door to groin time was 14.6 minutes (95% CI, 9.3-20.0) longer during off-hours. Door to needle times for intravenous therapy were slightly longer (3.5 minutes, 95% CI, 0.7-6.3) during off-hours. Groin puncture to reperfusion times did not differ between groups. For transferred patients, the delay within the intervention center was 5.0 minutes (95% CI, 0.5-9.6) longer. There was no significant difference in functional outcome between patients presenting during off- and on-hours (adjusted odds ratio, 0.92; 95% CI, 0.74-1.14). Reperfusion rates and complication rates were similar. Conclusions- Presentation during off-hours is associated with a slight delay in start of endovascular treatment in patients with acute ischemic stroke. This treatment delay did not translate into worse functional outcome or increased complication rates.

Keywords: delivery of health care; endovascular procedures; holidays; stroke; workflow.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Endovascular Procedures / methods*
Female
Humans
Male
Middle Aged
Observational Studies as Topic
Registries
Retrospective Studies
Stroke / surgery*
Time Factors
Time-to-Treatment
Workflow*