Association Between Stroke Presentation During Off-Hours and Mechanical Thrombectomy.

Area of Science:

• Neurology
• Emergency Medicine
• Public Health

Background:

• Mechanical thrombectomy (MT) is a crucial treatment for ischemic stroke, but access remains a concern in the United States.
• Potential staffing shortages may impact MT availability during non-standard working hours.

Purpose of the Study:

• To investigate the association between hospital presentation timing (on-hours vs. off-hours) and access to mechanical thrombectomy for ischemic stroke patients.
• To evaluate if extreme off-hours (midnight to 6 a.m.) affect MT rates compared to standard working hours.

Main Methods:

• Utilized 2016-2018 all-payer claims data from 11 US states, covering 80 million residents.
• Classified patient arrival times as 'on hours' (weekdays 8 a.m. - 6 p.m.) or 'off hours' (all other times).
• Employed multivariable logistic regression to analyze MT rates, including a sensitivity analysis for large-vessel occlusion patients.

Main Results:

• No significant difference in MT rates was observed between on-hours (3.4%) and off-hours (3.5%) presentations.
• Off-hours presentation was not significantly associated with lower odds of receiving MT (OR, 0.94; 95% CI, 0.85-1.03).
• Extreme off-hours presentation was associated with significantly lower odds of MT (OR, 0.83; 95% CI, 0.75-0.93).

Conclusions:

• Overall access to mechanical thrombectomy for ischemic stroke patients is consistent across regular and off-hours.
• Extreme off-hours present a barrier to mechanical thrombectomy, suggesting targeted interventions may be needed to improve access during these critical times.