Intravenous Thrombolysis in Acute Ischaemic Stroke Two Years into the COVID-19 Pandemic: A Retrospective Study
Publicado en línea: 01 jun 2024
Páginas: 29 - 38
DOI: https://doi.org/10.21307/ajon-2024-003
Palabras clave
© 2024 Sheila Jala et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Demographic and clinical characteristics
| Characteristic | Statistic | P-value | |
|---|---|---|---|
| Pre-COVID | During COVID | ||
| Ischaemic stroke admissions, n | 1041 | 1087 | |
| Received IVT, all stroke diagnoses, n | 229 | 186 | |
| Ischaemic stroke receiving IVT, n (%) | 200 (19.2) | 151 (13.9) | <0.001 |
| Age, years, median (IQR) | 77 (65-85) | 76 (62-85) | 0.434 |
| Gender, female, n (%) | 113 (49.3) | 83 (44.6) | 0.374 |
| Non-indigenous identity, n, (%) | 226 (98.7) | 184 (98.9) | 0.827 |
| NIHSS score, on admission, median (IQR) | 6 (2-13) | 5 (3-9) | 0.313 |
| NIHSS score, 24 hours post IVT, median (IQR) | 1 (1-4) | 1 (1-4) | 0.136 |
| NIHSS score, on admission, categorised, n (%) | 0.049 | ||
| No symptoms | 11 (4.8) | 8 (4.3) | 0.974 |
| Minor | 89 (38.9) | 72 (38.7) | 0.761 |
| Moderate | 84 (36.7) | 87 (46.8) | 0.024 |
| Moderate to severe | 17 (7.4) | 10 (5.4) | 0.400 |
| Severe | 28 (12.2) | 9 (4.8) | 0.009 |
| mRS before stroke treatment, median (IQR) | 0 (0-1) | 0 (0-1) | 0.327 |
| mRS on discharge, median (IQR) | 1 (1-4) | 1 (1-4) | 0.647 |
| mRS on discharge, cateogorised, n (%) | 0.522 | ||
| Score 0-1 | 121 (52.8) | 101 (54.3) | 0.766 |
| Score 2-3 | 32 (14.0) | 19 (10.2) | 0.246 |
| Score 4-5 | 56 (24.5) | 53 (28.5) | 0.419 |
| Score 6 | 20 (8.7) | 13 (7.0) | 0.655 |
| Time: symptom onset to ED, minutes, median (IQR) | 86 (62-130) | 107 (74-166) | 0.004 |
| Time: Door to CT scan, minutes, median (IQR) | 19 (13-29) | 22 (16-32) | 0.007 |
| Time: Door to Needle (IVT), minutes, median (IQR) | 59 (41-78) | 65 (53-85) | 0.002 |
| Time: onset to needle (IVT), minutes, median (IQR) | 160 (120-205) | 188 (144-240) | <0.001 |
| Length of stay: ED, minutes, median (IQR) | 157 (113-202) | 173 (131-216) | 0.011 |
| Length of stay: hospital, days, median (IQR) | 5 (3-8) | 5 (3-9) | 0.095 |
| Discharge stroke diagnosis, n (%) | 0.063 | ||
| Ischaemic | 200 (87.3) | 151 (81.2) | 0.084 |
| Transient ischaemic attack | 10 (4.4) | 6 (3.2) | 0.548 |
| Stroke mimic ( |
19 (8.3) | 29 (15.6) | 0.021 |
j.ajon-2024-003.tab.002
| Variables | Description |
|---|---|
Demographics: Age Gender Indigenous identity |
Age of patients in years Gender of patients (female, male, binary) Indigenous identity of patient (aboriginal/torres strait islander, non-aboriginal/torres strait islander) |
Stroke presentation: Presentation Admission |
Patient presented to hospital with stroke symptoms Patients admitted to the acute stroke unit |
| NIHSS | Stroke severity scale (admission, 24 hours post IVT) No symptoms - 0 Minor = 1-4 Moderate = 5-15 Moderate to severe = 16-20 Severe = 21-42 |
| mRS | Patient function (pre-stroke treatment, discharge) 0 = no symptom 1 = No significant disability. Able to carry out all usual activities, despite some symptoms 2 = Slight disability. Able to look after own affairs without assistance, but unable to carry out all previous activities 3 = Moderate disability. Requires some help, but able to walk unassisted 4 = Moderately severe disability. Unable to attend to own bodily needs without assistance, and unable to walk unassisted 5 = Severe disability. Requires constant nursing care and attention, bedridden, incontinent 6 = Dead |
Measure (Time in minutes): Symptom to ED time Door to CT time Door to Needle time Length of Stay |
Time from onset of first symptoms to presentation to ED Time patient spent in ED before CT imaging Time from patient presentation to hospital to administration of bolus dose of alteplase Patient length of stay (ED in minutes, hospital in days) |
Diagnosis Ischaemic Stroke |
Neurological symptoms due to the effect of decreased blood flow to particular areas of the brain that correlate with examination findings and infarct on the diffusion-weighted Magnetic Resonance Imaging (MRI) |
| TIA | Temporary focal neurological symptoms resulting from cerebral ischaemia that is not associated with infarction on diffusion-weighted MRI |
| Stroke mimic | Non-vascular conditions that present with an acute neurological deficit simulating acute ischaemic stroke |