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

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Mechanical thrombectomy (MT) access for stroke patients is similar during regular and off-hours. However, extreme off-hours, like midnight to 6 a.m., show decreased access to this critical stroke treatment.

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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.