Association between onset-to-door time and clinical outcomes after ischemic stroke

Ryu Matsuo, Yuko Yamaguchi, Tomonaga Matsushita, Jun Hata, Fumi Kiyuna, Kenji Fukuda, Yoshinobu Wakisaka, Junya Kuroda, Tetsuro Ago, Takanari Kitazono, Masahiro Kamouchi, Takao Ishitsuka, Setsuro Ibayashi, Kenji Kusuda, Kenichiro Fujii, Tetsuhiko Nagao, Yasushi Okada, Masahiro Yasaka, Hiroaki Ooboshi, Katsumi IrieTsuyoshi Omae, Kazunori Toyoda, Hiroshi Nakane, Hiroshi Sugimori, Shuji Arakawa, Jiro Kitayama, Shigeru Fujimoto, Shoji Arihiro, Yoshihisa Fukushima

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background and Purpose-The role of early hospital arrival in improving poststroke clinical outcomes in patients without reperfusion treatment remains unclear. This study aimed to determine whether early hospital arrival was associated with favorable outcomes in patients without reperfusion treatment or with minor stroke. Methods-This multicenter, hospital-based study included 6780 consecutive patients (aged, 69.9±12.2 years; 63.9% men) with ischemic stroke who were prospectively registered in Fukuoka, Japan, between July 2007 and December 2014. Onset-to-door time was categorized as T0-1, ≤1 hour; T1-2, >1 and ≤2 hours; T2-3, >2 and ≤3 hours; T3-6, >3 and ≤6 hours; T6-12, >6 and ≤12 hours; T12-24, >12 and ≤24 hours; and T24-, >24 hours. The main outcomes were neurological improvement (decrease in National Institutes of Health Stroke Scale score of ≥4 during hospitalization or 0 at discharge) and good functional outcome (3-month modified Rankin Scale score of 0-1). Associations between onset-to-door time and main outcomes were evaluated after adjusting for potential confounders using logistic regression analysis. Results-Odds ratios (95% confidence intervals) increased significantly with shorter onset-to-door times within 6 hours, for both neurological improvement (T0-1, 2.79 [2.28-3.42]; T1-2, 2.49 [2.02-3.07]; T2-3, 1.52 [1.21-1.92]; T3-6, 1.72 [1.44-2.05], with reference to T24-) and good functional outcome (T0-1, 2.68 [2.05-3.49], T1-2 2.10 [1.60-2.77], T2-3 1.53 [1.15-2.03], T3-6 1.31 [1.05-1.64], with reference to T24-), even after adjusting for potential confounding factors including reperfusion treatment and basal National Institutes of Health Stroke Scale. These associations were maintained in 6216 patients without reperfusion treatment and in 4793 patients with minor stroke (National Institutes of Health Stroke Scale ≤4 on hospital arrival). Conclusions-Early hospital arrival within 6 hours after stroke onset is associated with favorable outcomes after ischemic stroke, regardless of reperfusion treatment or stroke severity.

Original languageEnglish
Pages (from-to)3049-3056
Number of pages8
JournalStroke
Volume48
Issue number11
DOIs
Publication statusPublished - Nov 2017

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Stroke
Reperfusion
National Institutes of Health (U.S.)
Therapeutics
Japan
Hospitalization
Logistic Models
Odds Ratio
Regression Analysis
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

Cite this

Matsuo, R., Yamaguchi, Y., Matsushita, T., Hata, J., Kiyuna, F., Fukuda, K., ... Fukushima, Y. (2017). Association between onset-to-door time and clinical outcomes after ischemic stroke. Stroke, 48(11), 3049-3056. https://doi.org/10.1161/STROKEAHA.117.018132

Association between onset-to-door time and clinical outcomes after ischemic stroke. / Matsuo, Ryu; Yamaguchi, Yuko; Matsushita, Tomonaga; Hata, Jun; Kiyuna, Fumi; Fukuda, Kenji; Wakisaka, Yoshinobu; Kuroda, Junya; Ago, Tetsuro; Kitazono, Takanari; Kamouchi, Masahiro; Ishitsuka, Takao; Ibayashi, Setsuro; Kusuda, Kenji; Fujii, Kenichiro; Nagao, Tetsuhiko; Okada, Yasushi; Yasaka, Masahiro; Ooboshi, Hiroaki; Irie, Katsumi; Omae, Tsuyoshi; Toyoda, Kazunori; Nakane, Hiroshi; Sugimori, Hiroshi; Arakawa, Shuji; Kitayama, Jiro; Fujimoto, Shigeru; Arihiro, Shoji; Fukushima, Yoshihisa.

In: Stroke, Vol. 48, No. 11, 11.2017, p. 3049-3056.

Research output: Contribution to journalArticle

Matsuo, R, Yamaguchi, Y, Matsushita, T, Hata, J, Kiyuna, F, Fukuda, K, Wakisaka, Y, Kuroda, J, Ago, T, Kitazono, T, Kamouchi, M, Ishitsuka, T, Ibayashi, S, Kusuda, K, Fujii, K, Nagao, T, Okada, Y, Yasaka, M, Ooboshi, H, Irie, K, Omae, T, Toyoda, K, Nakane, H, Sugimori, H, Arakawa, S, Kitayama, J, Fujimoto, S, Arihiro, S & Fukushima, Y 2017, 'Association between onset-to-door time and clinical outcomes after ischemic stroke', Stroke, vol. 48, no. 11, pp. 3049-3056. https://doi.org/10.1161/STROKEAHA.117.018132
Matsuo, Ryu ; Yamaguchi, Yuko ; Matsushita, Tomonaga ; Hata, Jun ; Kiyuna, Fumi ; Fukuda, Kenji ; Wakisaka, Yoshinobu ; Kuroda, Junya ; Ago, Tetsuro ; Kitazono, Takanari ; Kamouchi, Masahiro ; Ishitsuka, Takao ; Ibayashi, Setsuro ; Kusuda, Kenji ; Fujii, Kenichiro ; Nagao, Tetsuhiko ; Okada, Yasushi ; Yasaka, Masahiro ; Ooboshi, Hiroaki ; Irie, Katsumi ; Omae, Tsuyoshi ; Toyoda, Kazunori ; Nakane, Hiroshi ; Sugimori, Hiroshi ; Arakawa, Shuji ; Kitayama, Jiro ; Fujimoto, Shigeru ; Arihiro, Shoji ; Fukushima, Yoshihisa. / Association between onset-to-door time and clinical outcomes after ischemic stroke. In: Stroke. 2017 ; Vol. 48, No. 11. pp. 3049-3056.
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abstract = "Background and Purpose-The role of early hospital arrival in improving poststroke clinical outcomes in patients without reperfusion treatment remains unclear. This study aimed to determine whether early hospital arrival was associated with favorable outcomes in patients without reperfusion treatment or with minor stroke. Methods-This multicenter, hospital-based study included 6780 consecutive patients (aged, 69.9±12.2 years; 63.9{\%} men) with ischemic stroke who were prospectively registered in Fukuoka, Japan, between July 2007 and December 2014. Onset-to-door time was categorized as T0-1, ≤1 hour; T1-2, >1 and ≤2 hours; T2-3, >2 and ≤3 hours; T3-6, >3 and ≤6 hours; T6-12, >6 and ≤12 hours; T12-24, >12 and ≤24 hours; and T24-, >24 hours. The main outcomes were neurological improvement (decrease in National Institutes of Health Stroke Scale score of ≥4 during hospitalization or 0 at discharge) and good functional outcome (3-month modified Rankin Scale score of 0-1). Associations between onset-to-door time and main outcomes were evaluated after adjusting for potential confounders using logistic regression analysis. Results-Odds ratios (95{\%} confidence intervals) increased significantly with shorter onset-to-door times within 6 hours, for both neurological improvement (T0-1, 2.79 [2.28-3.42]; T1-2, 2.49 [2.02-3.07]; T2-3, 1.52 [1.21-1.92]; T3-6, 1.72 [1.44-2.05], with reference to T24-) and good functional outcome (T0-1, 2.68 [2.05-3.49], T1-2 2.10 [1.60-2.77], T2-3 1.53 [1.15-2.03], T3-6 1.31 [1.05-1.64], with reference to T24-), even after adjusting for potential confounding factors including reperfusion treatment and basal National Institutes of Health Stroke Scale. These associations were maintained in 6216 patients without reperfusion treatment and in 4793 patients with minor stroke (National Institutes of Health Stroke Scale ≤4 on hospital arrival). Conclusions-Early hospital arrival within 6 hours after stroke onset is associated with favorable outcomes after ischemic stroke, regardless of reperfusion treatment or stroke severity.",
author = "Ryu Matsuo and Yuko Yamaguchi and Tomonaga Matsushita and Jun Hata and Fumi Kiyuna and Kenji Fukuda and Yoshinobu Wakisaka and Junya Kuroda and Tetsuro Ago and Takanari Kitazono and Masahiro Kamouchi and Takao Ishitsuka and Setsuro Ibayashi and Kenji Kusuda and Kenichiro Fujii and Tetsuhiko Nagao and Yasushi Okada and Masahiro Yasaka and Hiroaki Ooboshi and Katsumi Irie and Tsuyoshi Omae and Kazunori Toyoda and Hiroshi Nakane and Hiroshi Sugimori and Shuji Arakawa and Jiro Kitayama and Shigeru Fujimoto and Shoji Arihiro and Yoshihisa Fukushima",
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TY - JOUR

T1 - Association between onset-to-door time and clinical outcomes after ischemic stroke

AU - Matsuo, Ryu

AU - Yamaguchi, Yuko

AU - Matsushita, Tomonaga

AU - Hata, Jun

AU - Kiyuna, Fumi

AU - Fukuda, Kenji

AU - Wakisaka, Yoshinobu

AU - Kuroda, Junya

AU - Ago, Tetsuro

AU - Kitazono, Takanari

AU - Kamouchi, Masahiro

AU - Ishitsuka, Takao

AU - Ibayashi, Setsuro

AU - Kusuda, Kenji

AU - Fujii, Kenichiro

AU - Nagao, Tetsuhiko

AU - Okada, Yasushi

AU - Yasaka, Masahiro

AU - Ooboshi, Hiroaki

AU - Irie, Katsumi

AU - Omae, Tsuyoshi

AU - Toyoda, Kazunori

AU - Nakane, Hiroshi

AU - Sugimori, Hiroshi

AU - Arakawa, Shuji

AU - Kitayama, Jiro

AU - Fujimoto, Shigeru

AU - Arihiro, Shoji

AU - Fukushima, Yoshihisa

PY - 2017/11

Y1 - 2017/11

N2 - Background and Purpose-The role of early hospital arrival in improving poststroke clinical outcomes in patients without reperfusion treatment remains unclear. This study aimed to determine whether early hospital arrival was associated with favorable outcomes in patients without reperfusion treatment or with minor stroke. Methods-This multicenter, hospital-based study included 6780 consecutive patients (aged, 69.9±12.2 years; 63.9% men) with ischemic stroke who were prospectively registered in Fukuoka, Japan, between July 2007 and December 2014. Onset-to-door time was categorized as T0-1, ≤1 hour; T1-2, >1 and ≤2 hours; T2-3, >2 and ≤3 hours; T3-6, >3 and ≤6 hours; T6-12, >6 and ≤12 hours; T12-24, >12 and ≤24 hours; and T24-, >24 hours. The main outcomes were neurological improvement (decrease in National Institutes of Health Stroke Scale score of ≥4 during hospitalization or 0 at discharge) and good functional outcome (3-month modified Rankin Scale score of 0-1). Associations between onset-to-door time and main outcomes were evaluated after adjusting for potential confounders using logistic regression analysis. Results-Odds ratios (95% confidence intervals) increased significantly with shorter onset-to-door times within 6 hours, for both neurological improvement (T0-1, 2.79 [2.28-3.42]; T1-2, 2.49 [2.02-3.07]; T2-3, 1.52 [1.21-1.92]; T3-6, 1.72 [1.44-2.05], with reference to T24-) and good functional outcome (T0-1, 2.68 [2.05-3.49], T1-2 2.10 [1.60-2.77], T2-3 1.53 [1.15-2.03], T3-6 1.31 [1.05-1.64], with reference to T24-), even after adjusting for potential confounding factors including reperfusion treatment and basal National Institutes of Health Stroke Scale. These associations were maintained in 6216 patients without reperfusion treatment and in 4793 patients with minor stroke (National Institutes of Health Stroke Scale ≤4 on hospital arrival). Conclusions-Early hospital arrival within 6 hours after stroke onset is associated with favorable outcomes after ischemic stroke, regardless of reperfusion treatment or stroke severity.

AB - Background and Purpose-The role of early hospital arrival in improving poststroke clinical outcomes in patients without reperfusion treatment remains unclear. This study aimed to determine whether early hospital arrival was associated with favorable outcomes in patients without reperfusion treatment or with minor stroke. Methods-This multicenter, hospital-based study included 6780 consecutive patients (aged, 69.9±12.2 years; 63.9% men) with ischemic stroke who were prospectively registered in Fukuoka, Japan, between July 2007 and December 2014. Onset-to-door time was categorized as T0-1, ≤1 hour; T1-2, >1 and ≤2 hours; T2-3, >2 and ≤3 hours; T3-6, >3 and ≤6 hours; T6-12, >6 and ≤12 hours; T12-24, >12 and ≤24 hours; and T24-, >24 hours. The main outcomes were neurological improvement (decrease in National Institutes of Health Stroke Scale score of ≥4 during hospitalization or 0 at discharge) and good functional outcome (3-month modified Rankin Scale score of 0-1). Associations between onset-to-door time and main outcomes were evaluated after adjusting for potential confounders using logistic regression analysis. Results-Odds ratios (95% confidence intervals) increased significantly with shorter onset-to-door times within 6 hours, for both neurological improvement (T0-1, 2.79 [2.28-3.42]; T1-2, 2.49 [2.02-3.07]; T2-3, 1.52 [1.21-1.92]; T3-6, 1.72 [1.44-2.05], with reference to T24-) and good functional outcome (T0-1, 2.68 [2.05-3.49], T1-2 2.10 [1.60-2.77], T2-3 1.53 [1.15-2.03], T3-6 1.31 [1.05-1.64], with reference to T24-), even after adjusting for potential confounding factors including reperfusion treatment and basal National Institutes of Health Stroke Scale. These associations were maintained in 6216 patients without reperfusion treatment and in 4793 patients with minor stroke (National Institutes of Health Stroke Scale ≤4 on hospital arrival). Conclusions-Early hospital arrival within 6 hours after stroke onset is associated with favorable outcomes after ischemic stroke, regardless of reperfusion treatment or stroke severity.

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