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Requena M, Olivé M, García-Tornel Á, Rodríguez-Villatoro N, Deck M, Juega J, Boned S, Muchada M, Piñana C, Coscojuela P, Pagola J, Rodríguez-Luna D, Hernández D, Rubiera M, Molina CA, Tomasello A, Ribo M. Time Matters. Stroke 2020; 51:1766-1771. [DOI: 10.1161/strokeaha.119.028586] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Direct transfer to angiography-suite (DTAS) protocol is a promising measure to improve onset to recanalization time in patients who undergo endovascular treatment. The magnitude of the improvement of good outcome rates in function of time depends of several factors. We aim to analyze the benefit of DTAS according to time from symptom onset.
Methods—
Retrospective case-control study of 174 consecutive DTAS cases matched with 175 patients initially transferred to computed tomography (directly transferred to computed tomography) from February 2016 to June 2019. To obtain comparable groups on admission, cases and controls were matched by occlusion location, age (±2 years), baseline National Institutes of Health Stroke Scale score (±2 points), and time from symptoms onset to hospital arrival (±30 minutes). We analyzed the rate of good functional outcome at 3 months (modified Rankin Scale score, 0–2) and safety variables stratified in less or more than 3 hours from onset to arrive.
Results—
There were no significant differences regarding age, sex, or baseline National Institutes of Health Stroke Scale score. Median door-to-groin time was shorter in the DTAS patients (16 [3–21] minutes versus 70 [41.5–98.5];
P
<0.01). DTAS patients presented lower National Institutes of Health Stroke Scale score at 24 hours (9 [3.5–17] versus 14 [5–19];
P
=0.01) and a lower rate of symptomatic hemorrhagic transformation (4.6% versus 10.9%,
P
<0.03). At 90 days, DTAS patients had a higher rate of good functional outcome (43% versus 29%; odds ratio, 1.81 [95% CI, 1.14–2.87];
P
=0.01). Better outcome in DTAS was observed in patients admitted in the 0 to 3 hours form onset window (n=156, odds ratio 2.63 [95% CI, 1.31–5.28];
P
<0.01), but not in patients admitted in the 3 to 6 hours window (n=193, odds ratio, 1.37 [95% CI, 0.72–2.60];
P
=0.2).
Conclusions—
DTAS seems a feasible and safe strategy to improve functional outcome in patients who undergo endovascular treatment mainly within 3 hours from symptoms onset.
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Affiliation(s)
- Manuel Requena
- From the Stroke Unit, Neurology Department (M. Requena, M.O., A.G.-T., N.R.-V., M.D., J.J., S.B., M.M., J.P., D.R.-L. M. Rubiera, C.A.M., M. Ribo), Vall d’Hebron University Hospital, Barcelona, Spain
- Departament de Medicina, Universitat Autónoma de Barcelona, Spain (M. Requena, M.O., A.G.-T., J.J.,)
- Stroke Research Group, Vall d’Hebron Research Institute (M. Requena, A.G.-T., N.R.-V., M.D., J.J., S.B., M.M., J.P., D.R.-L., M. Rubiera, C.A.M., M. Ribo)
| | - Marta Olivé
- From the Stroke Unit, Neurology Department (M. Requena, M.O., A.G.-T., N.R.-V., M.D., J.J., S.B., M.M., J.P., D.R.-L. M. Rubiera, C.A.M., M. Ribo), Vall d’Hebron University Hospital, Barcelona, Spain
- Departament de Medicina, Universitat Autónoma de Barcelona, Spain (M. Requena, M.O., A.G.-T., J.J.,)
| | - Álvaro García-Tornel
- From the Stroke Unit, Neurology Department (M. Requena, M.O., A.G.-T., N.R.-V., M.D., J.J., S.B., M.M., J.P., D.R.-L. M. Rubiera, C.A.M., M. Ribo), Vall d’Hebron University Hospital, Barcelona, Spain
- Departament de Medicina, Universitat Autónoma de Barcelona, Spain (M. Requena, M.O., A.G.-T., J.J.,)
- Stroke Research Group, Vall d’Hebron Research Institute (M. Requena, A.G.-T., N.R.-V., M.D., J.J., S.B., M.M., J.P., D.R.-L., M. Rubiera, C.A.M., M. Ribo)
| | - Noelia Rodríguez-Villatoro
- From the Stroke Unit, Neurology Department (M. Requena, M.O., A.G.-T., N.R.-V., M.D., J.J., S.B., M.M., J.P., D.R.-L. M. Rubiera, C.A.M., M. Ribo), Vall d’Hebron University Hospital, Barcelona, Spain
- Stroke Research Group, Vall d’Hebron Research Institute (M. Requena, A.G.-T., N.R.-V., M.D., J.J., S.B., M.M., J.P., D.R.-L., M. Rubiera, C.A.M., M. Ribo)
| | - Matías Deck
- From the Stroke Unit, Neurology Department (M. Requena, M.O., A.G.-T., N.R.-V., M.D., J.J., S.B., M.M., J.P., D.R.-L. M. Rubiera, C.A.M., M. Ribo), Vall d’Hebron University Hospital, Barcelona, Spain
- Stroke Research Group, Vall d’Hebron Research Institute (M. Requena, A.G.-T., N.R.-V., M.D., J.J., S.B., M.M., J.P., D.R.-L., M. Rubiera, C.A.M., M. Ribo)
| | - Jesús Juega
- From the Stroke Unit, Neurology Department (M. Requena, M.O., A.G.-T., N.R.-V., M.D., J.J., S.B., M.M., J.P., D.R.-L. M. Rubiera, C.A.M., M. Ribo), Vall d’Hebron University Hospital, Barcelona, Spain
- Departament de Medicina, Universitat Autónoma de Barcelona, Spain (M. Requena, M.O., A.G.-T., J.J.,)
- Stroke Research Group, Vall d’Hebron Research Institute (M. Requena, A.G.-T., N.R.-V., M.D., J.J., S.B., M.M., J.P., D.R.-L., M. Rubiera, C.A.M., M. Ribo)
| | - Sandra Boned
- From the Stroke Unit, Neurology Department (M. Requena, M.O., A.G.-T., N.R.-V., M.D., J.J., S.B., M.M., J.P., D.R.-L. M. Rubiera, C.A.M., M. Ribo), Vall d’Hebron University Hospital, Barcelona, Spain
- Stroke Research Group, Vall d’Hebron Research Institute (M. Requena, A.G.-T., N.R.-V., M.D., J.J., S.B., M.M., J.P., D.R.-L., M. Rubiera, C.A.M., M. Ribo)
| | - Marian Muchada
- From the Stroke Unit, Neurology Department (M. Requena, M.O., A.G.-T., N.R.-V., M.D., J.J., S.B., M.M., J.P., D.R.-L. M. Rubiera, C.A.M., M. Ribo), Vall d’Hebron University Hospital, Barcelona, Spain
- Stroke Research Group, Vall d’Hebron Research Institute (M. Requena, A.G.-T., N.R.-V., M.D., J.J., S.B., M.M., J.P., D.R.-L., M. Rubiera, C.A.M., M. Ribo)
| | - Carlos Piñana
- Department of Neuroradiology (C.P., P.C., D.H., A.T.), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Pilar Coscojuela
- Department of Neuroradiology (C.P., P.C., D.H., A.T.), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Jorge Pagola
- From the Stroke Unit, Neurology Department (M. Requena, M.O., A.G.-T., N.R.-V., M.D., J.J., S.B., M.M., J.P., D.R.-L. M. Rubiera, C.A.M., M. Ribo), Vall d’Hebron University Hospital, Barcelona, Spain
- Stroke Research Group, Vall d’Hebron Research Institute (M. Requena, A.G.-T., N.R.-V., M.D., J.J., S.B., M.M., J.P., D.R.-L., M. Rubiera, C.A.M., M. Ribo)
| | - David Rodríguez-Luna
- From the Stroke Unit, Neurology Department (M. Requena, M.O., A.G.-T., N.R.-V., M.D., J.J., S.B., M.M., J.P., D.R.-L. M. Rubiera, C.A.M., M. Ribo), Vall d’Hebron University Hospital, Barcelona, Spain
- Stroke Research Group, Vall d’Hebron Research Institute (M. Requena, A.G.-T., N.R.-V., M.D., J.J., S.B., M.M., J.P., D.R.-L., M. Rubiera, C.A.M., M. Ribo)
| | - David Hernández
- Department of Neuroradiology (C.P., P.C., D.H., A.T.), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Marta Rubiera
- From the Stroke Unit, Neurology Department (M. Requena, M.O., A.G.-T., N.R.-V., M.D., J.J., S.B., M.M., J.P., D.R.-L. M. Rubiera, C.A.M., M. Ribo), Vall d’Hebron University Hospital, Barcelona, Spain
- Stroke Research Group, Vall d’Hebron Research Institute (M. Requena, A.G.-T., N.R.-V., M.D., J.J., S.B., M.M., J.P., D.R.-L., M. Rubiera, C.A.M., M. Ribo)
| | - Carlos A. Molina
- From the Stroke Unit, Neurology Department (M. Requena, M.O., A.G.-T., N.R.-V., M.D., J.J., S.B., M.M., J.P., D.R.-L. M. Rubiera, C.A.M., M. Ribo), Vall d’Hebron University Hospital, Barcelona, Spain
- Stroke Research Group, Vall d’Hebron Research Institute (M. Requena, A.G.-T., N.R.-V., M.D., J.J., S.B., M.M., J.P., D.R.-L., M. Rubiera, C.A.M., M. Ribo)
| | - Alejandro Tomasello
- Department of Neuroradiology (C.P., P.C., D.H., A.T.), Vall d’Hebron University Hospital, Barcelona, Spain
| | - Marc Ribo
- From the Stroke Unit, Neurology Department (M. Requena, M.O., A.G.-T., N.R.-V., M.D., J.J., S.B., M.M., J.P., D.R.-L. M. Rubiera, C.A.M., M. Ribo), Vall d’Hebron University Hospital, Barcelona, Spain
- Stroke Research Group, Vall d’Hebron Research Institute (M. Requena, A.G.-T., N.R.-V., M.D., J.J., S.B., M.M., J.P., D.R.-L., M. Rubiera, C.A.M., M. Ribo)
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9
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Bonfert MV, Badura K, Gerstl J, Borggraefe I, Heinen F, Schroeder S, Olivieri M, Weinberger R, Landgraf MN, Vill K, Tacke M, Berweck S, Reiter K, Hoffmann F, Nicolai T, Gerstl L. Childhood Stroke: Awareness, Interest, and Knowledge Among the Pediatric Community. Front Pediatr 2018; 6:182. [PMID: 29988546 PMCID: PMC6026646 DOI: 10.3389/fped.2018.00182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/04/2018] [Indexed: 12/11/2022] Open
Abstract
Objective: Acute childhood stroke is an emergency requiring a high level of awareness among first-line healthcare providers. This survey serves as an indicator of the awareness of, the interest in, and knowledge of childhood stroke of German pediatricians. Methods: Thousand six hundred and ninety-seven physicians of pediatric in- and outpatient facilities in Bavaria, Germany, were invited via email to an online-survey about childhood stroke. Results: The overall participation rate was 14%. Forty-six percent of participants considered a diagnosis of childhood stroke at least once during the past year, and 47% provide care for patients who have suffered childhood stroke. The acronym FAST (Face-Arm-Speech-Time-Test) was correctly cited in 27% of the questionnaires. Most commonly quoted symptoms of childhood stroke were hemiparesis (90%), speech disorder (58%), seizure (44%), headache (40%), and impaired consciousness (33%). Migraine (63%), seizure (39%), and infections of the brain (31%) were most frequently named as stroke mimics. Main diagnostic measures indicated were magnetic resonance imaging (MRI) (96%) and computer tomography (CT) (55%). Main therapeutic strategies were thrombolysis (80%), anticoagulation (41%), neuroprotective measures, and thrombectomies (15% each). Thirty-nine percent of participants had taken part in training sessions, 61% studied literature, 37% discussed with colleagues, and 25% performed internet research on childhood stroke. Ninety-three percent of participants approve skill enhancement, favoring training sessions (80%), publications (43%), and web based offers (35%). Consent for offering a flyer on the topic to caregivers in facilities was given in 49%. Conclusion: Childhood stroke constitutes a topic of clinical importance to pediatricians. Participants demonstrate a considerable level of comprehension concerning the subject, but room for improvement remains. A multi-modal approach encompassing an elaborate training program, regular educational publications in professional journals, and web based offers could reach a broad range of health care providers. Paired with a public adult and childhood stroke awareness campaign, these efforts could contribute to optimize the care for children suffering from stroke.
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Affiliation(s)
- Michaela V Bonfert
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Katharina Badura
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany.,Schön Klinik Vogtareuth, Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Vogtareuth, Germany
| | - Julia Gerstl
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany.,Department of Pediatrics, Facharztzentrum Hauzenberg, Hauzenberg, Germany
| | - Ingo Borggraefe
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Florian Heinen
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Sebastian Schroeder
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Martin Olivieri
- Department of Pediatric Hemostaseology, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany.,Pediatric Intensive Care Unit, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Raphael Weinberger
- Division of Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Mirjam N Landgraf
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Katharina Vill
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Moritz Tacke
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Steffen Berweck
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany.,Schön Klinik Vogtareuth, Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Vogtareuth, Germany
| | - Karl Reiter
- Pediatric Intensive Care Unit, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Florian Hoffmann
- Pediatric Intensive Care Unit, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Thomas Nicolai
- Pediatric Intensive Care Unit, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Lucia Gerstl
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilians University of Munich, Munich, Germany
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