To determine impact of time of presentation to hospital outside of regular “business hours” on door-to-needle time (DTN) in patients with acute ischemic strokes (AIS).

Door-to-needle time (DTN) is associated with outcomes in acute ischemic stroke (AIS) patients, who are eligible to receive intravenous tissue plasminogen activator (IV tPA). Various factors have been shown to impact DTN time including patient-related factors such as initial refusal or management of hypertension on admission; hospital-related factors such as time to imaging; and system-related factors, all potentially affecting clinical outcomes.

This was a retrospective chart review of prospectively collected data through Get-with-the-Guidelines from Jan-2015 to Dec-2018 at our comprehensive stroke center. Patient demographics, medical history including vascular risk factors, last known well time, arrival time, door-to-CT time, treatment time, admission National Institutes of Health stroke scale (NIHSS), pre-stroke modified Rankin scale (mRS) were analyzed. To analyze differences in medians for continuous variables, the Kruskal-Wallis test was used, and Fisher’s exact test was used for categorical variables.  

Of 280 patients (mean age 72 years; 51% men) who received IV tPA in the emergency department (ED), 39% of patients were treated on weekdays during business hours, while 61% were treated after hours on weekdays or on weekends. Median DTN time and Onset-to-treatment times (OTT) were significantly lower during business hours (p=0.04) without any significant difference in patient characteristics between groups including age (71 vs 72 years, p=0.75), gender, ethnicity, admission NIHSS (5 vs 6, p=0.14), vascular risk factors, door-to-CT times (12 minutes in both groups, p=0.8) and presence or absence of major hemispheric cortical signs at presentation.

We found significant differences in treatment times with respect to IV tPA depending on whether patients presented during regular business hours or after hours. This “weekend effect” for acute stroke therapy has the potential to influence clinical outcomes.