Deans' stroke musings: Association Between Onset-to-Door Time and Clinical Outcomes After Ischemic Stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, October 31, 2017

Association Between Onset-to-Door Time and Clinical Outcomes After Ischemic Stroke

All these words and nothing useful was said. Exactly how fast should arrival at hospital occur? Then how fast should DTN occur? Without that specific knowledge you have no clue what actions need to be taken to meet those timelines. Damn it all learn about cause and effect.
http://stroke.ahajournals.org/content/48/11/3049?etoc=

Ryu Matsuo, Yuko Yamaguchi, , , Fumi Kiyuna, Kenji Fukuda, Yoshinobu Wakisaka, Junya Kuroda, , Takanari Kitazono, , on behalf of the Fukuoka Stroke Registry Investigators†

https://doi.org/10.1161/STROKEAHA.117.018132 Originally published October 3, 2017

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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 T_0-1, ≤1 hour; T_1-2, >1 and ≤2 hours; T_2-3, >2 and ≤3 hours; T_3-6, >3 and ≤6 hours; T_6-12, >6 and ≤12 hours; T_12-24, >12 and ≤24 hours; and T_24-, >>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 (T_0-₁, 2.79 [2.28–3.42]; T_1-2, 2.49 [2.02–3.07]; T_2-3, 1.52 [1.21–1.92]; T_3-6, 1.72 [1.44–2.05], with reference to T_24-) and good functional outcome (T_0-1, 2.68 [2.05–3.49], T_1-2 2.10 [1.60–2.77], T_2-3 1.53 [1.15–2.03], T_3-6 1.31 [1.05–1.64], with reference to T_24-), 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.