Door-to-Needle Time in Acute Stroke Treatment and the “July Effect”

Be careful out there. Make sure you choose the correct time of year and have classic stroke symptoms so your doctors will treat you properly.
http://journals.sagepub.com/doi/abs/10.1177/1941874417733108

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Maximiliano A. Hawkes, MD, Federico Carpani, MD, Mauricio F. Farez, MD, MPh, ...

First Published September 27, 2017 Brief Report

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Abstract

Intravenous thrombolysis improves outcomes in acute ischemic stroke in a time-dependent fashion. As in teaching hospitals, clinical outcomes may worsen due to the arrival of new inexperienced house staff early in the academic year (July effect, JE), we evaluated the impact of the “JE” on the door-to-needle time for intravenous thrombolysis and other stroke outcomes. In this retrospective cohort study, we assessed all acute ischemic strokes treated with intravenous thrombolysis between July 2003 and June 2016. Among 101 patients, there was no detrimental July effect on the door-to-needle time, rate of thrombolysis within 60 minutes of arrival, thrombolysis of stroke mimics, post-thrombolysis intracranial hemorrhages, National Institutes of Health Stroke Scale, and modified Rankin Scale outcomes.

An Epidemiological Study of Stroke in a large tertiary care teaching hospital of northern India

Whatever this is about.  

An Epidemiological Study of Stroke in a large tertiary care teaching hospital of northern India

Kaul R R 

Additional Professor, Community Medicine

Tabish S A

Professor & Head Hospital Administration - Corresponding Author 

Khan Z A

Ex Postgraduate, Community Medicine

Shiekh S

Ex Professor Neurology

Rafiq Ahmad

Associate Professor, Community Medicine

ABSTRACT

: Stroke causes a greater range of disabilities than any other condition. Where stroke mortalities are declining or stabilizing in developed  countries, experts  are  concerned  of  the  emerging  epidemic of  stroke  in  India. Various   risk  factors  and  determinants  of  stroke  are  on  rise  and  so  is  the  risk  of  stroke. Reliable   morbidity and  mortality  estimates  for  stroke  in  India  are  limited  due  to  incomplete  death  certification,  incorrect  death  classification,   and uncertainty    of  etiology  in cases of sudden death of multiple co-morbidities.

 Methodology

: The  study  was  conducted  at   the  premier  hospital  of  Jammu  &  Kashmir, an  800  bedded  referral  hospital,  Sher-i-Kashmir Institute  of   Medical  Sciences (SKIMS), Srinagar. Study  group  included  all  the  established  cases  of  stroke  diagnosed  on  the basis  of  WHO  definition  of  stroke, clinical history and detailed examination fulfilling the inclusion criteria. The diagnosis of stroke was confirmed by neuro-imaging techniques. Cranial Computerized tomography (CT) Scan was done in all cases and wherever CT scan was normal, Magnetic resonance (MRI) was used as confirmative tool for establishing the diagnosis of stroke. Information was sought from the stroke patients of a close family member using  predesigned and pretested questionnaire which included question pertaining to the socio-demographic variables and the information about the various factors associated with stroke. Various factors that were studied included hypertension, diabetes mellitus, hyperlipidemia, cardiac diseases (like rheumatic heart disease, Atrial fibrillation, etc.), tobacco exposure, pshyco-social stress, alcohol abuse, use of oral anticoagulant drugs, use of oral contraceptives in case of females, family or past history of stroke, dietary habits and physical inactivity. The data was tabulated and analyzed  by bivariate and multivariate analysis with the help of SPSS for WINDOWS (version 20).

Results

: During one year of study, a total of 46613 patients were admitted in the hospital, among which 1438 were diagnosed to have a stroke. Thus almost 3 out of 100 hospital admissions were due to stroke. The total incidence (per 100 admissions) was observed to be around 30.85.

Conclusion:

 3.08% of all admissions in SKIMS hospital during one year were due to stroke. There is predominance of hemorrhagic strokes over ischemic strokes as 75% of the stroke cases are hemorrhagic. Hypertension, diabetes mellitus, tobacco abuse, hyperlipidemia and overweight/ obesity were the most prevalent modifiable risk factors among these stroke patients.