Effect of admission time on provision of acute stroke treatment at stroke units and stroke centers-An analysis of the Swiss Stroke Registry

Valerian L Altersberger; Patrick R Wright; Sabine A Schaedelin; Gian Marco De Marchis; Henrik Gensicke; Stefan T Engelter; Marios Psychogios; Timo Kahles; Martina Goeldlin; Thomas R Meinel; Pasquale Mordasini; Johannes Kaesmacher; Alexander von Hessling; Jochen Vehoff; Johannes Weber; Susanne Wegener; Stephan Salmen; Rolf Sturzenegger; Friedrich Medlin; Christian Berger; Ludwig Schelosky; Susanne Renaud; Julien Niederhauser; Christophe Bonvin; Michael Schaerer; Marie-Luise Mono; Biljana Rodic; Guido Schwegler; Nils Peters; Manuel Bolognese; Andreas R Luft; Carlo W Cereda; Georg Kägi; Patrick Michel; Emmanuel Carrera; Marcel Arnold; Urs Fischer; Krassen Nedeltchev; Leo H Bonati

doi:10.1177/23969873221094408

Effect of admission time on provision of acute stroke treatment at stroke units and stroke centers-An analysis of the Swiss Stroke Registry

Eur Stroke J. 2022 Jun;7(2):117-125. doi: 10.1177/23969873221094408. Epub 2022 Apr 27.

Authors

Valerian L Altersberger¹, Patrick R Wright², Sabine A Schaedelin², Gian Marco De Marchis¹, Henrik Gensicke^{1

3}, Stefan T Engelter^{1

3}, Marios Psychogios⁴, Timo Kahles⁵, Martina Goeldlin⁶, Thomas R Meinel⁶, Pasquale Mordasini⁷, Johannes Kaesmacher⁷, Alexander von Hessling⁸, Jochen Vehoff⁹, Johannes Weber⁹, Susanne Wegener¹⁰, Stephan Salmen¹¹, Rolf Sturzenegger¹², Friedrich Medlin¹³, Christian Berger¹⁴, Ludwig Schelosky¹⁵, Susanne Renaud¹⁶, Julien Niederhauser¹⁷, Christophe Bonvin¹⁸, Michael Schaerer¹⁹, Marie-Luise Mono²⁰, Biljana Rodic²¹, Guido Schwegler²², Nils Peters²³, Manuel Bolognese⁸, Andreas R Luft^{10

24}, Carlo W Cereda²⁵, Georg Kägi^{6

9}, Patrick Michel²⁶, Emmanuel Carrera²⁷, Marcel Arnold⁶, Urs Fischer^{1

6}, Krassen Nedeltchev⁵, Leo H Bonati¹

Affiliations

¹ Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland.
² Clinical Trial Unit, University Hospital Basel and University of Basel, Basel, Switzerland.
³ Neurorehabilitation, University of Basel and University Department of Geriatic Medicine FELIX PLATTER, University of Basel, Switzerland.
⁴ Department of Neuroradiology, University Hospital Basel and University of Basel, Basel, Switzerland.
⁵ Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland.
⁶ Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
⁷ University Institute of Diagnostic and Interventional Neuroradiology and University Institute of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital Inselspital Bern, and University of Bern, Bern, Switzerland.
⁸ Cantonal Hospital Lucerne, Luzern, Switzerland.
⁹ Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
¹⁰ Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
¹¹ Department of Neurology, Spitalzentrum Biel, Biel, Switzerland.
¹² Cantonal hospital Graubuenden, Chur, Switzerland.
¹³ Department of Internal Medicine, Stroke Unit and Division of Neurology, HFR Fribourg, Cantonal Hospital, Fribourg, Switzerland.
¹⁴ Stroke Unit, Hospital Grabs, Grabs, Switzerland.
¹⁵ Cantonal Hospital Muensterlingen, Munsterlingen, Switzerland.
¹⁶ Stroke Unit and Division of Neurology, Neuchatel Hospital Network, Neuchatel, Switzerland.
¹⁷ Stroke Unit, Hôpital Nyon, Switzerland.
¹⁸ Spital Sion, Sion, Switzerland.
¹⁹ Bürgerspital Solothurn, Solothurn, Switzerland.
²⁰ Stadtspital Triemli Zürich, Switzerland.
²¹ Cantonal Hospital Winterthur, Winterthur, Switzerland.
²² Spital Limmattal, Schlieren, Switzerland.
²³ Stroke Center, Hirslanden Hospital Zurich, Zurich, Switzerland.
²⁴ Cereneo Center for Neurology and Rehabilitation, Weggis, Switzerland.
²⁵ Stroke Center and Department of Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland.
²⁶ Department of Neurology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
²⁷ Department of Neurology, HUG Geneve, Geneve, Switzerland.

Abstract

Introduction: Rapid treatment of acute ischemic stroke (AIS) depends on sufficient staffing which differs between Stroke Centers and Stroke Units in Switzerland. We studied the effect of admission time on performance measures of AIS treatment and related temporal trends over time.

Patients and methods: We compared treatment rates, door-to-image-time, door-to-needle-time, and door-to-groin-puncture-time in stroke patients admitted during office hours (Monday-Friday 8:00-17:59) and non-office hours at all certified Stroke Centers and Stroke Units in Switzerland, as well as secular trends thereof between 2014 and 2019, using data from the Swiss Stroke Registry. Secondary outcomes were modified Rankin Scale and mortality at 3 months.

Results: Data were eligible for analysis in 31,788 (90.2%) of 35,261 patients. Treatment rates for IVT/EVT were higher during non-office hours compared with office hours in Stroke Centers (40.8 vs 36.5%) and Stroke Units (21.8 vs 18.5%). Door-to-image-time and door-to-needle-time increased significantly during non-office hours. Median (IQR) door-to-groin-puncture-time at Stroke Centers was longer during non-office hours compared to office hours (84 (59-116) vs 95 (66-130) minutes). Admission during non-office hours was independently associated with worse functional outcome (1.11 [95%CI: 1.04-1.18]) and increased mortality (1.13 [95%CI: 1.01-1.27]). From 2014 to 2019, median door-to-groin-puncture-time improved and the treatment rate for wake-up strokes increased.

Discussion and conclusion: Despite differences in staffing, patient admission during non-office hours delayed IVT to a similar, modest degree at Stroke Centers and Stroke Units. A larger delay of EVT was observed during non-office hours, but Stroke Centers sped up delivery of EVT over time. Patients admitted during non-office hours had worse functional outcomes, which was not explained by treatment delays.

Keywords: Stroke; admission time; outcome; quality of care; service provision.