학술논문
Association of Time of Day With Outcomes Among Patients Triaged for a Suspected Severe Stroke in Nonurban Catalonia
Document Type
Academic Journal
Author
García-Tornel, Álvaro; Flores, Alan; Terceño, Mikel; Cardona, Pedro; Amaro, Sergi; Gomis, Meritxell; Zaragoza, Josep; Krupinski, Jerzy; Gómez-Choco, Manuel; Mas, Natalia; Cocho, Dolores; Catena, Esther; Purroy, Francesc; Deck, Matias; Rubiera, Marta; Pagola, Jorge; Rodriguez-Luna, David; Juega, Jesús; Rodríguez-Villatoro, Noelia; Molina, Carlos A.; Soro, Cristina; Jimenez, Xavier; Salvat-Plana, Mercè; Dávalos, Antoni; Jovin, Tudor G; Abilleira, Sonia; Pérez de la Ossa, Natalia; Ribó, Marc; Sanjuan, Estela; Santana, Katherine; Maisterra, Olga; Santamarina, Estevo; Muchada, Marian; Boned, Sandra; Franco, Antonio Palasi; Gadea, Marta Olivé; Deck, Matías; Requena, Manuel; Sala, Victoria; Muñoz, Lucía; Millán, Mónica; López-Cancio, Elena; Dorado, Laura; Hernández-Pérez, María; Ciurans, Jordi; Samaniego, Daniela; Canento, Tamara; Martin, Lorena; Planas, Anna; Broto, Joaquin; Sorrentino, Agustín; Paré, Martí; Zhu, Nuole; Garrido, Alicia; Grau, Laia; Crespo, Ane Miren; Presas, Silvia; Almendrote, Miriam; Ramos, Alba; Lucente, Giuseppe; Ispierto, Lourdes; Lozano, Manuel; Becerra, Juan Luis; Jiménez, Marta; Rolán, Dolores Vilas; Guanyabens, Nicolas; Sanchez-Ojanguren, Josep; Martínez-Piñeiro, Alicia; Forcén, Sara; Gea, Mireia; Álvarez, Marta; Ramos, Anna; Lizarbe, Manuel Domínguez; Guerra, Rubio; Bragado, Irene; Arbex, Andrea; Rodríguez, Luis; Bustamante, Alejandro; Portela, Pere Cardona; García, Helena Quesada; Rodríguez, Blanca Lara; Cayuela, Nuria; Miró, Julia; Marzal, Clara; Paipa, Andrés; Campoy, Sergio; Núñez, Ana; Arroyo, Pablo; Besora, Sarah; Adell, Vanessa; Campdelacreu, Jaume; Martí, Montse Alemany; González, Belén; Vila, Laura Bau; Crespo, Marta Fiter; Berbel, Anna; Urbaneja, Ma. Cristina Villaescusa; Guillen, Núria; Vidal, Nuria; Santamaria, Patricia Valentina Vérez; Navarro, Diego Herrero; Simó, Marta; Falip, Mercedes; Matas, Elisabeth; Ochoa, Neus Mongay; Gifreu, Ariadna; Muñoz, Albert; Romero, Lucía; Portell, Eduard; Perez, Guillermo Hernández; Esteve, F. Ruiz; Teixidor, Silvia; Talavera, Augusto Salazar; Gómez, Roser; Nuin, Xabier Urra; Vargas, Martha; Chamorro, Ángel; Llull, Laura; Renú, Arturo; Rudilosso, Salvatore; del Valle, Raquel Sánchez; Ariño, Helena; Solà, Nuria; la Puma, Delón; Gil, Francisco; Gómez, Juan Bernardo; Matos, Nuria; Falgàs, Neus; Borrego, Sergi; Sánchez, Almudena; Balasa, Mircea; Montejo, Carmen; Guasp, Mar; Reyes, David; Cervilla, Pablo Sánchez; Contador, Jose Miguel; Monge, Victor Augusto Vera; Ramos, Oscar; Rodríguez, Alejandro; Campello, Ana Rodríguez; Ballester, Gemma Romeral; Trujillano, Mireia Llop; Steinhauer, Eva Giralt; Godia, Elisa Cuadrado; Santiago, Angel Javier Ois; Conde, Jordi Jimenez; Fábregas, Joan Martí; Guisado, Daniel; Prats, Luís; Camps, Pol; Delgado, Raquel; Domeño, Alejandro Martínez; Marín, Rebeca; Cànovas, David; Estela, Jordi; Ros, Marta; Aranceta, Sonsoles; Espinosa, Jordi; Rubio, Marta; Lafuente, Cristina; Barrachina, Oriol; Anguita, Alicia; Reverter, Anna; García, Carmen; Sansa, Gemma; Hervas, Mariona; Crosas, Monica; Delgado, Tania; Folch, Dra Sonia Huertas; Gamito, Gemma Muñoz; Alvarez, Josep Trenado; Subirana, Teresa; Molina, Jessica; Besora, Sarah; Romero, Laura Comes; Valls, Gemma Guardia; Jover, Miriam; Sotova, Javier Joaquín; García Sánchez, Sonia Mª; Valenzuela, Sebastian; Mengual, Juan José; Font, M. Àngels; Gómez Ruiz, Mª Isabel; Zubizarreta, Irati; González, Susana Fernández; Gubieras, Laura; Cobos, Carmen E.; Romo, Luis Mena; Caballol, Nuria; Cano, Luis; Leal, Joaquín Serena; Blas, Yolanda Silva; Trigo, Irene Bragado; Viturro, Saima Bashir; Albiñana, Laura Pardo; Garrido, Montserrat Reina; Cazcarra, Carla Marco; Uscamaita, Karol Enrique; Márquez, Fabian; Coll, Cristina; Villlas, Mar Irida Lloret; Vila, Berta Solano; Perna, Berta Alemany; Domínguezl, Daniel López; de Lera, Mercedes; Foraster, Anna Cots; Monge, Victor Augusto Vera; Bojaryn, Urszula; Benabdelhak, Ikram; Capdevila, Gerard Mauri; Montesinos, Jordi Sanahuja; Vázquez, Daniel; Hervás, José Vicente; González, Cristina; Quílez, Alejandro; Pascual, Mikel Vicente; Ruiz, María; Riba, Yolanda; Villar, M. Pilar Gil; García, Cristina; Roig, Xavier Ustrell; Mora, Mònica Baldrich; Guinjoan, Anna Pellisé; Borras, Judit; Martínez, Alba Mañé; Marés, Rafael; Viñas i Gaya, Jaume; Seró, Laia; Rodríguez, Paula; Castilho, Gislaine; Ortega, Angela Monterde; Reverté, Silvia; Baiges, Joan Josep; Ozaeta, Gisela Martín; Escalante, Sonia; Belloch, Patricia Esteve; Payo, Iago; Salvado, Júlia Saura; Soler Insa, Josep M; Vilamala, Ester Tio; Navarro, Josep Abos; Tabuenca, Héctor Cruz; Sánchez, Tamara Canento; Ros, Marta; Matos, Nuria; Roldán, Elisabet; Rubiol, Elsa Puiggrós; Franquet, Elisabet; Fuentes, Lidia; Donaire, Javier; Martí, Elena; Giménez, Laura; Vázquez, Junior Gil; Ambrós, Eloisa Nieto Clara Gris; Rodríguez, Puri; Oletta, José Félix; Mellado, Pilar Pons; Gómez, Bárbara; Raileau, Vergilin; Pardina, Oscar; Mercadal, Jordi; López-Diéguez, María; Pérez, Pilar; Gabarró, Lourdes; Orriols, María; Molina, José Carlos; Canet, Joan Josep; Roca, Mireia; Álvaro, Muriel; Boneu, Francesc; Giménez, Georgina; Albà, Jaume; Gibert, Francesc; Garcia, Jéssica; Barragan, Patricia; Jurado, Gustavo; Pascual_Medicina Interna, Vanesa; Ortega, Josep Sabaté; Solano, Joan Amaurys Martínez; Fernández, Víctor; Torres, Mónica; Alvaredo, Ana Belén Montero; Parejo, Laura Redondo; Aragonés, Josep Maria; Bullón, Anna; Loste, Cora; González, Paula; Bejarano, Neker; Sanchez, Francisco; Lucchetti, Gianni; Pla, Xavier; Gimeno, Dr Javier; Reynaga, Esteban; Barcons, Montse; Celedón, Gabriel; Ortiz, Juan; Anastasovski, Dr Goran; Mascaró, Dr Oscar; de los Ríos, Dr Javier Diez; Feliu, Meritxell; Ribera, Anna; Ruiz, Cristhian; Corominas, Gerard; Nunes, Dra Daniella; Roca, Claudia; Latorre, Nadina; Yataco, Lizbeth; Cruz, Maricelys; Blanco, Nerea; Castejón, Santiago; Sunyer, Claustre Pont; Garcia, Jordi Espinosa; Martin, Rodrigo Paz; de Luis Sanchez, Albert; Vivas, Dolores Espinosa; Molina, Juan Valencia; Palome, Planels; Chaume, Laia Tomas; Vilella, Ares Villagrasa; Bustamante, Marco; Boltes, Anunciación; Rodríguez, Fernando; Arrieta, Itziar; Molist, Jordi Ciurans; Andreu, Barnés; Soler, Ernest Palomeras; Buscà, Nicolau Guanyabens; López, Manuel Daza; Farreres, Jordi Bigas; Ruiz, Virginia Casado; Batiste, Desiree Muriana; Sanz Cartagena, Mª Pilar; de Vega, Eulalia Cabot; Real, Josep Bassa; Roman, Hector Pelaez; Socolich, César; Alonso Camp, Josep Mª; Orgaz, Antonio Tomás Cano; Fossas Felip, Mª Pilar; Morón, Nicolás; Bacca, Sandra; Molina, Mauricio; Casarramona, Francesc; Elias, Lorena; Bukaei, Muhammad Zidane; Gutierrez, Jose Antonio Martos; Escuin, Judith Lopez; Olaizola, Cristina; Vargas, Yolexis López; Oyonarte, Juan Jiménez; Soultana, Rashida; Golpe, Eduardo Sanjurjo; Salvador, Esther; Vila, Guillem; Serrano, Marcos; Claverol, Matilde Nuria López; Lamolla, Marian; Amate, Miquel; Rodriguez, Adriana; Romero, Ruth; del Carpio, Montgomery; Hernandez, Ana Isabel; Martín, Julián; Rosas, M Carmen; Nogueroles, Antonio; Encarnación, Sorilandy; Robles, Augusto; Herrera, Jose Antonio; Gavilán, Roger; Mameghani, Toghrol; Araujo, Gastón; Morales, M.Angeles Garrido; Segui, Enric Ramon Albert; Climent, Eva Fernandez; Pujol, Francesc Paris; Seira, Mireia Judit Garrofé; Pía, Lucía Gómez; Nuñez, Fernando Salleres; Peñalver, Cristina Aguar; Lopes, Cristina Vaz; Tasa, Elisenda Ribera; Vilchez, Carmen Repullo; Zambrana, Modesto Sánchez; Ribas, Beatriu Suescun; Panés, Inés Vilà; Planavila, Montserrat Vila; Lorenzo, Alicia Vaqueiro; Guixes, Meritxell Sabartés; Medina, Jorge; Sambrano, David; Zamarreño, Javi; Pirela, Carmen; Vélez, Paola; Cajamarca, Luis; Pérez, Honey; Martínez, Yarles; Gonçalves, Jesus Alexander; Regordosa, Carles; Mormeneo, Claudia; Griu, Laura; Colina, Maria Francia; Farik, Enric; Duch, Dolors Carrión; Badenas, Carles; Bernal, Oscar; Agramunt, Núria; Morales, Shyrlei; Reynoso, Victoria; Guerrero, Miguel; Cid, Primitivo Romera; Folqué, Mònica; Pedroza, Claudia; Hachem, Adnan; Martínez, Íñigo Soteras; García, Xavier Verdera; Amorós, Mercè López; Subirós, Xavier Costa; Benet, Marta Cufí; Van Eendenburg, Cecile; Osuna, Teresa; Santos, Dra Gina; Pallisera, Dra Mireia; Oliva, Dr Lluís Gonzalo; Sanchez, Dra Gemma; Basurto, Dr Xavier; Vivoda, Dr Ludgi; Van der Kleyn, Dr Richard; Robles, Dra Laura; Barranco, Ana Cabanelas; Almendros, Mª Cruz; Oliveras, Marc Pérez; Álvarez, Amelia Fernández; Rybyeva, Maria; Viñas, Antoni; Barcons, Maria; Tavera, Joaquim Danès Alberto; Burbano, Pablo; López, Cintie; Cruz, David; Bisbe, Paula; Fernández, Nora; Palacio, Juan Carlos; Fraiz, Eduardo; Aguiló, Oriol; Amorodjo, Rollmy; Velázquez, John; Sánchez, Elena; Español, Jaume; Perez de Celis, Judit; Coll, Anna; Díaz, Glòria; Vergés i Sala, Margarida; Casas Capdevila, Mª Ángels; Ferrini, Yosmairy Yoselin; Gorriz, Aitor; Navarro, Diego-Javier Cucurell; Velásquez, Dulce; Pla Soler, Jaume; González, Josep; Higuera, Julian David; Cuellar, Lina; Miniello, Liza Margarita; Pujol, Lluis; Cracan, Sorin; Vives, Mora; Angela, M; Lopez, Lopez; Molist, Montse Gorchs; Anna, Delofeu; Muñoz, Silvia Solà; Yolanda, Ferreres; Pujalte, Carol; Marín, Elisabeth Téllez; Casas, Yolanda Font; Luque, Sara Hernández; Sendra, Joaquim Mejias; Valero, Francesca Mellado; Escala, Campos; De Lacanal, Galup; Diaz, Lopez; Paramio, Castillo; Estopà, Català; Moreda, Español; Majo, Calafell; Almeida, Carballo; Naval, Castro; Elena, M; Ruiz, Cregut; Lluis, Pere; Font, Deulofeu; Sanjuan, Fabregat; Pere, Joan; Gorchs, Fontquerni; Bellés, Forés; Antoni, Joan; Herrera, Gomez; Carlos, Juan; Prades, Hijazo; Torvisco, Itzaina; Rovira, Marti; Gonzalez, Obiols; Cavero, Olive; Gil, Querol; Soledad, M; Rodriguez, Rico; Sambernardo, Rios; Molina, Ropero; Ramon, Jose; Valero, Sanchez; Arevalo, Santos; Jose, Maria; Garcia, Soto; Angeles, Maria; Escribano, Tebar; Garcia, Torres; José, Pedro; Carrion, Verdes; Isabel, M; Lopez, Verge; Jose, Juan; Canela, Lopez; Angeles, M; Guarque, Lucas; Alvarez, Morales; Arnulfo, Jorge; Fornieles, Morell; Gomez, Subirats; Teresa, Maria; Masa, Miquel, Torello; Lopez, Val; Mercedes, Maria; Reyes, Palmero; Manuel, Juan; Forne, Rodriguez; Turiel, Ruana; Gonzalez, Sanchez; Gornals, Sebastia; Rico, Abrio; Falip, Albert Gual; Oliveros, Aznar; Perotti, Brugues; Molinero, Calvet; Franco, Catells; Medina, Corrales; Miro, Daroca; Marquez, Duran; Pradas, Feliu; Casanova, Figueras; Tortajada, Garcia; Gallego, Grajera; del Mar, Azahara; Arroyo, Las; de Jesus, Dulcenombre; Sanz, Laserreta; Vidal, Llambrich; Corral, Monllao; de la Cruz, Morales; Blanco, Moreno; Orgaz, Orejuela; Suazo, Piñana; Minguillon, Pons; Gómez, Rodríguez; Carlos, José; Pereira, Rodriguez; Porcel, Anna, Sedo; Villar, Sevil; Lopez, Sierra; Romero, Torres; Calveres, Anna, Trepat; Arnella, Ventura; Gil, Acera; Teresa, M; Vico, Biesot; Galea, Castro; Maria, Rosa; Chafer, Escorcia; Antonio, Juan; Moreda, Español; Faure, Gil; Luque, Hernandez; Delgado, Jimenez; Gay, Mallafre; Angel, M.; Sanzo, Olivares; Fondevila, Pubill; Fort, Sabate; Agámez, Segovia; Carlos, Antonio; Longaretti, Turata; Hernandez, Valle; Guixens, Trayner; Valor, Aguilar; Alvarez, Aguirre; Naval, Alastrue; Baquero, Alferez; Marne, Alonso; Orozco, Aloy; Colino, Alvarez; Peñuela, Alvarez; Cirilo, Ameller; Vanessa, Maria; Guerrero, Andujar; Remedios, Estefania; Sillero, Auladell; Sorbet, Azcarate; Genesca, Basany; Barduena, Benavent; Tudela, Benito; Pardo, Blanch; Pla, Boluda; Gonzalez, Bonilla; Serramalera, Bru; Andreu, Burnat; Calvo-Rayo, Caballero; Casellas, Calvo; Mombiela, Camps; Bresme, Cano; Fernandez, Carcelen; Solà, Caro; Matavacas, Casasas; Bolado, Castanedo; Cortina, Cerdeña; Jane, Abella; Borrego, Laia Collado; Orri, Colom; Vilanova, Comellas; Sole, Conillera; Torres, Cots; Estepa, Cuchi; de Sostoa Graell, Marc; del Rio Lopez, Laura; Compte, Delgado; Bueno, Diaz; Maneiro, Diaz; Lucia, Andrea; Palau, Domenech; Carme, M.; Carasso, Duran; Javier, Pablo; Marquez, Duran; Abidi, El; Martin, Escoda; Casanovas, Esteve; Perez, Fernandez; Quintero, Ferre; Escobar, Flores; Abad, Fontcuberta; del Valle, Fortes; del Valle, Fortes; Luisa, Mª; Quesada, Franco; Maria, Sara; Romero, Franco; Teresa, Maria; Francisco, Gallego; Gala, Gamiz; Castañeda, Garcia; Rodriguez, Garcia; Gemma, Casajuana; Arroyo, Gomez; Girbau, Gomez; Fernandez, Gonzalez; Gonzalez, Gonzalez; Gonzalez, Gonzalez; Lopez, Gonzalez; Obeso, Gual; Blanco, Guerrero; Roca, Guillemas; Eudaldo, Guillermo; Hernandez, Sebastia; Covas, Homar; Alvarez, Hostench; Royo, Huerta; Barcelo, Ibañez; Cruz, Izquiero; Etxetxikia, Jaione Urdangarin; Gimenez, Juárez; Alami, Khlifi; Gasco, Laparra; Moreales, Lara; Arroyo, Las; de Jesus, Dulcenombre; Medina, Lasaosa; Lourdes, Maria; Cava, Lazaro; Berrar, Leon; Maturana, López; Ramirez, Lopez; Romero, López; Marco, Lorente; Martin, Lorenzo; Casals, Lozano; Nicola, Lujan; Diaz, Madrid; Antonio, Jose; Morales, Maria Teresa Peris; Clemente, Marti; Castaño, Martinez; Natanael, David; Gamez, Martinez; Gonzalez, Martinez; Quesada, Martinez; de la Cabeza, Maria; Fusté, Marzà; Lasheras, Melendo; Mestre, Miralles; Pastalle, Montserrat Puig; Vidal, Montserrate; Mellado, Mora; Ponce, Morales; Fornieles, Morell; Cabre, Morera; Vivet, Morera; Souza, Mundi; Quiles, Muñoz; Rosa, Navea; Iglesias, Neira; Asuncion, M; Manrique, Nuñez; Pilar, Mª; Martinez, Obiols; Reig, Pallares; Torres, Partegas; Berengueras, Pascual; Gamez, Perez; Oset, Perez; Restrepo, Perez; Alejandra, Maria; Yeste, Planas; Mangado, Planells; Minguillon, Pons; Carbonell, Puertas; Blanco, Quinteiro; Benavente, Rebollar; Fernandez, Recasens; Gomez, Reyes; del Carmen, Maria; Pou, Roca; Ferrer, Rodriguez; Franco, Rodriguez; Fuertes, Rodriguez; Muñoz, Rodriguez; Navarro, Rodriguez; Iniesta, Roig; Gracia, Romero; Brunet, Rovira; de Eugenio, Rovira; Baena, Rubio; Llorens, Ruiz; Llamazares, Sala; Alaez, San Juan; Segura, Sanchez; Soldevilla, Santasusana; Salmeron, Sanz; Perez, Segura; Balcells, Serra; Dumitras, Sorina; Montoya, Teixidor; Vicente, Tena; Salinas, Tierno; Ines, Ester; Testa, Toledo; Figueras, Tomàs; Ruperez, Tomas; Garcia-Penche, Torrano; Esparza, Torres; Blanco, Vazquez; De la Paz, Vazquez; Gil, Vazquez; Gonzalez, Vazquez; Meler, Vidal; Cots, Vilalta; Jimenez, Vilches; Jose, Maria; Fernandez, Visser; Gavin, Viu; Vives, Vives; Jimenez, Carmona; Jose, Francisco; Vilches, Galobardes; Gomez, Gonzalez; Manzanera, Jodar; Cortes, Marimon; Orive, Marrodan; Bosch, Martin; Jose, Maria; Lopez, Martorell; Roca, Millares; Jesus, M; Guri, Miralles; Hernandez, Muliterno; Oliva, Muñoz; Pujol, Pons; Conde, Postius; Arruñada, Prieto; Antonio, Jose; Mathé, Quintana; Mata, Rosell; Alvarez, Aguirre; Alvarez, Alvarin; Flores, Arrufat; Pago, Bañuelos; Andreu, Burnat; Vilar, Campo; Hidalgo, Cardus; Gil, Castello; Gloria, Maria; Montsesinos, Castrillo; Estopà, Català; Garces, Clave; Sanroma, Comes; Sequi, Descalzo; Ricol, Errando; Campillo, Escudero; del Mar, Maria; Alvarez, Fernandez; Gomez, Fernandez; Perez, Fernandez; Espinosa, Franch; Graells, Freixes; Plaza, Garcia; Gallego, Garcia-Marron; Simancas, Hernandez; Covas, Homar; Royo, Huerta; Armas, Jaraba; Ramos, Jimenez; Canela, Lopez; Angeles, M; Lopez, Lopez; Oganissian, Lopez; Romero, Madrona; Rosa, M; Millan, Martinez; Morón, Martínez; Encinas, Merchan; Fornieles, Morell; Jimenez, Moreno; Rico, Muñoz; Rodriguez, Navarro; Ibañez, Nogales; Maria, Rita; Viera, Novillo; Torrabadella, Parella; Alba, Mari; Villar, Pera; Montserrat, Carla; Carbonell, Puertas; Miralles, Rabella; Trilles, Ramis; Ortiz, Ribera; Fuertes, Rodriguez; Gonzalez, Sanchez; Perez, Sastre; Perez, Segura; Borrega, Soro; Garcia, Soto; Angeles, Maria; Fores, Tapia; Bernad, Tellez; Alvarez, Trenado; Moreda, Español; Martin, Felix; Perez, Herrero; Manzanera, Jodar; Fuster, Lanau; Gomariz, Lopez; Orive, Marrodan; Bosch, Martin; Jose, Maria; Guri, Miralles; Oliva, Muñoz; Lozano, Pardo; Pujol, Pons; Altimiras, Quintana; Lopez, Ventosa; Damian, Almodovar; Colino, Alvarez; Monterroso, Alvarez; Comas, Arambudo; Garzon, Boullon; Capella, Burgos; Garcia, Campuzano; Del Mar, Maria; Olivas, Capdevila; Fernandez, Carcelen; Solà, Caro; Marti, Carre; Isabel, Clara; Bacaicoa, Carretero; Gil, Castello; Gloria, Maria; Montsesinos, Castrillo; Calderon, Cazorla; Osuna, Chacon; Planas, Cortes; Olio, Cortit; Estany, Delhomme; Carasso, Duran; Javier, Pablo; Campillo, Escudero; del Mar, Maria; Martinez, Fructuos; Lopez, Garcia; Luis, Pascual; Plaza, Garcia; Vallve, Genis Amill; Arroyo, Gomez; Girbau, Gomez; Muñoz, Gonzalez; Ventura, Hernaez; Covas, Homar; Gimenez, Lavernia; Rojo, Martin; Medina, Martínez; Millan, Martinez; Barrera, Mayol; Pi, Mercader; Dalmau, Merino; Campodarbe, Miguel; Pastalle, Montserrat Puig; de la Cruz, Morales; Fornieles, Morell; Sanchez, Moreno; Javier, Francisco; Reig, Pallares; Torrabadella, Parella; Alba, Mari; Barrameda, Penela; Ajenjo, Prieto; Benavente, Rebollar; Pareja, Rodriguez; Piñar, Rodríguez; Javier, Francisco; Tello, Rodriguez; Pereda, Romero; Saborido, Sainz; Martin, Santacana; Martinez, Santos; Chavez, Sierra; Testa, Toledo; Figueras, Tomàs; Garcia, Torres; José, Pedro; Torres, Turbau; Domenech, Vicente; Esteo, Villena; Pertegaz, Vives; Gonzalez, Baena; Pont, Bagaria; Sanchez, Beltran; Alarcon, Bonet; Ballescà, Borch; Clanchet, Buhils; Garcia, Closa; Carril, Colomina; Sanchez, Cristina Fernandez; Toledo, Edurne Judith Fernandez; Rodriguez, Espases; Resa, Espert; Xavier, F; Sol, Fernández; Lugo, Gonzalez; Llesera, Gracia; Lendinez, Herrada; Liesa, Juliench; Alicia, Sandra; Ortega, Lopez; Yuste, Lopez; Villanueva, Lozano; Soto, Lucia Sola; Castellano, Madrid; Cano, Megias; Jesus, Daniel; Ponce, Montasell; Sospedra, Montesinos; Martinez, Moya; Herrera, Muñoz; Isabel, M; Fernandez, Ocaña; Jose, Maria; Bernal, Palau; Sole, Perez; Carbonell, Ramon; Lop, Ribas; López, Rubio; Lopez, Rueda; Castaño, Sabat; Lara, Sabata; Ramírez, Salmerón; Gornals, Sebastia; Creus, Serra; Dalmau, Serrano; Mainero, Sumasi; Gabriel, Gonzalo; Masa, Torello; Primo, Valencia; Muñoz, Ana Maria Viñuales; Roig, Josep; Hidalgo, Verònica
Source
Stroke. Mar 01, 2023 54(3):770-780
Subject
Language
English
ISSN
0039-2499
Abstract
BACKGROUND:: We aim to assess whether time of day modified the treatment effect in the RACECAT trial (Direct Transfer to an Endovascular Center Compared to Transfer to the Closest Stroke Center in Acute Stroke Patients With Suspected Large Vessel Occlusion Trial), a cluster-randomized trial that did not demonstrate the benefit of direct transportation to a thrombectomy-capable center versus nearest local stroke center for patients with a suspected large vessel stroke triaged in nonurban Catalonia between March 2017 and June 2020. METHODS:: We performed a post hoc analysis of RACECAT to evaluate if the association between initial transport routing and functional outcome differed according to trial enrollment time: daytime (8:00 AM–8:59 PM) and nighttime (9:00 PM–7:59 AM). Primary outcome was disability at 90 days, as assessed by the shift analysis on the modified Rankin Scale score, in patients with ischemic stroke. Subgroup analyses according to stroke subtype were evaluated. RESULTS:: We included 949 patients with an ischemic stroke, of whom 258 patients(27%) were enrolled during nighttime. Among patients enrolled during nighttime, direct transport to a thrombectomy-capable center was associated with lower degrees of disability at 90 days (adjusted common odds ratio [acOR], 1.620 [95% CI, 1.020–2.551]); no significant difference between trial groups was present during daytime (acOR, 0.890 [95% CI, 0.680–1.163]; Pinteraction=0.014). Influence of nighttime on the treatment effect was only evident in patients with large vessel occlusion(daytime, acOR 0.766 [95% CI, 0.548–1.072]; nighttime, acOR, 1.785 [95% CI, 1.024–3.112] ; Pinteraction<0.01); no heterogeneity was observed for other stroke subtypes (Pinteraction>0.1 for all comparisons). We observed longer delays in alteplase administration, interhospital transfers, and mechanical thrombectomy initiation during nighttime in patients allocated to local stroke centers. CONCLUSIONS:: Among patients evaluated during nighttime for a suspected acute severe stroke in non-urban areas of Catalonia, direct transport to a thrombectomy-capable center was associated with lower degrees of disability at 90 days. This association was only evident in patients with confirmed large vessel occlusion on vascular imaging. Time delays in alteplase administration and interhospital transfers might mediate the observed differences in clinical outcome. REGISTRATION:: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02795962.