Impact of Hospital Admission During Nonworking Hours on Patient Outcomes After Thrombolysis for Stroke

Background and Purpose-Whether the time of hospital admission is relevant for short-term outcome after stroke is under debate and may depend on care facilities. Methods-We retrospectively analyzed medical records from patients who received thrombolytic therapy within 4.5 hours of stroke onset in a stroke unit of the Charite-University Hospital Berlin (Charite; n=291) or within the stroke telemedicine (TEMPiS) network, comprising 12 community hospitals with telestroke units in Bavaria (n=616). Results-Thrombolytic therapy was administered during nonworking hours in 59.5% (Charite) and 55.0% (TEMPiS) of patients. A trend toward a lower rate of symptomatic intracranial hemorrhage (3.4% versus 9.2%; P=0.053), clinical worsening (11.9% versus 19.7%; P=0.079), and 7-day mortality (3.4% versus 8.7%; P=0.073) after admission during working hours was seen at Charite. However, multivariable analysis did not show a significant impact of the time of admission on clinical worsening, symptomatic intracranial hemorrhage, or 7-day mortality in both cohorts. Thrombolysis based on brain computed tomography instead of magnetic resonance imaging (odds ratio=4.98, 95% CI, 1.09 to 22.7) and more severe National Institutes of Health Stroke Scale score on admission (odds ratio=1.15 per point; 95% CI, 1.07 to 1.24) were associated with 7-day mortality at Charite. National Institutes of Health Stroke Scale score on admission (odds ratio=1.13 per point; 95% CI, 1.06 to 1.19) and older age (odds ratio=1.05 per year; 95% CI, 1.004 to 1.09) were correlated with 7-day mortality in TEMPiS. National Institutes of Health Stroke Scale on admission was the only independent predictor of symptomatic intracranial hemorrhage or clinical worsening in both cohorts. Conclusions-The majority of stroke patients received thrombolysis during nonworking hours. The time of hospital admission did not significantly influence the short-term outcome after thrombolysis. (Stroke. 2011;42:2521-2525.)