The "golden hour" and acute brain ischemia

Presenting features and lytic therapy in >30 000 patients arriving within 60 minutes of stroke onset

Jeffrey L. Saver, Eric E. Smith, Gregg C. Fonarow, Mathew J. Reeves, Xin Zhao, Daiwai M. Olson, Lee H. Schwamm

Research output: Contribution to journalArticle

123 Citations (Scopus)

Abstract

Background and purpose: The benefit of intravenous thrombolytic therapy in acute brain ischemia is strongly time dependent. Methods: The Get With the Guidelines-Stroke database was analyzed to characterize ischemic stroke patients arriving at hospital Emergency Departments within 60 minutes of the last known well time from April 1, 2003, to December 30, 2007. Results: During the 4.75-year study period, among 253 148 ischemic stroke patients arriving directly by ambulance or private vehicle at 905 hospital Emergency Departments, 106 924 (42.2%) had documented, exact last known well times. Onset to door time was ≤60 minutes in 30 220 (28.3%), 61 to 180 minutes in 33 858 (31.7%), and >180 minutes in 42 846 (40.1%). Features most strongly distinguishing the patients arriving at ≤60, 61 to 180, and >180 minutes were greater stroke severity (median National Institutes of Health Stroke Scale score, 8.0 vs 6.0 vs 4.0, P<0.0001) and more frequent arrival by ambulance (79.0%. vs 72.2% vs 55.0%, P<0.0001). Compared with patients arriving at 61 to 180 minute, "golden hour" patients received intravenous thrombolytic therapy more frequently (27.1% vs 12.9%; odds ratio=2.51; 95% CI, 2.41-2.61; P<0.0001), but door-to-needle time was longer (mean, 90.6 vs 76.7 minutes, P<0.0001). A door-to-needle time of ≤60 minutes was achieved in 18.3% of golden hour patients. Conclusions: At Get With the Guidelines-Stroke hospital Emergency Departments, more than one quarter of patients with documented onset time and at least one eighth of all ischemic stroke patients arrived within 1 hour of onset, where they received thrombolytic therapy more frequently but more slowly than late arrivers. These findings support public health initiates to increase early presentation and shorten door-to-needle times in patients arriving within the golden hour.

Original languageEnglish (US)
Pages (from-to)1431-1439
Number of pages9
JournalStroke
Volume41
Issue number7
DOIs
StatePublished - Jul 2010

Fingerprint

Brain Ischemia
Stroke
Thrombolytic Therapy
Hospital Departments
Needles
Hospital Emergency Service
Ambulances
Therapeutics
Guidelines
National Institutes of Health (U.S.)
Public Health
Odds Ratio
Databases

Keywords

  • acute care
  • acute stroke
  • acute therapy
  • emergency medical services
  • emergency medicine
  • stroke care
  • stroke delivery
  • therapy
  • thrombolysis
  • thrombolytic therapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing
  • Medicine(all)

Cite this

The "golden hour" and acute brain ischemia : Presenting features and lytic therapy in >30 000 patients arriving within 60 minutes of stroke onset. / Saver, Jeffrey L.; Smith, Eric E.; Fonarow, Gregg C.; Reeves, Mathew J.; Zhao, Xin; Olson, Daiwai M.; Schwamm, Lee H.

In: Stroke, Vol. 41, No. 7, 07.2010, p. 1431-1439.

Research output: Contribution to journalArticle

Saver, Jeffrey L. ; Smith, Eric E. ; Fonarow, Gregg C. ; Reeves, Mathew J. ; Zhao, Xin ; Olson, Daiwai M. ; Schwamm, Lee H. / The "golden hour" and acute brain ischemia : Presenting features and lytic therapy in >30 000 patients arriving within 60 minutes of stroke onset. In: Stroke. 2010 ; Vol. 41, No. 7. pp. 1431-1439.
@article{e5abf012c5334140b247f0271c678b41,
title = "The {"}golden hour{"} and acute brain ischemia: Presenting features and lytic therapy in >30 000 patients arriving within 60 minutes of stroke onset",
abstract = "Background and purpose: The benefit of intravenous thrombolytic therapy in acute brain ischemia is strongly time dependent. Methods: The Get With the Guidelines-Stroke database was analyzed to characterize ischemic stroke patients arriving at hospital Emergency Departments within 60 minutes of the last known well time from April 1, 2003, to December 30, 2007. Results: During the 4.75-year study period, among 253 148 ischemic stroke patients arriving directly by ambulance or private vehicle at 905 hospital Emergency Departments, 106 924 (42.2{\%}) had documented, exact last known well times. Onset to door time was ≤60 minutes in 30 220 (28.3{\%}), 61 to 180 minutes in 33 858 (31.7{\%}), and >180 minutes in 42 846 (40.1{\%}). Features most strongly distinguishing the patients arriving at ≤60, 61 to 180, and >180 minutes were greater stroke severity (median National Institutes of Health Stroke Scale score, 8.0 vs 6.0 vs 4.0, P<0.0001) and more frequent arrival by ambulance (79.0{\%}. vs 72.2{\%} vs 55.0{\%}, P<0.0001). Compared with patients arriving at 61 to 180 minute, {"}golden hour{"} patients received intravenous thrombolytic therapy more frequently (27.1{\%} vs 12.9{\%}; odds ratio=2.51; 95{\%} CI, 2.41-2.61; P<0.0001), but door-to-needle time was longer (mean, 90.6 vs 76.7 minutes, P<0.0001). A door-to-needle time of ≤60 minutes was achieved in 18.3{\%} of golden hour patients. Conclusions: At Get With the Guidelines-Stroke hospital Emergency Departments, more than one quarter of patients with documented onset time and at least one eighth of all ischemic stroke patients arrived within 1 hour of onset, where they received thrombolytic therapy more frequently but more slowly than late arrivers. These findings support public health initiates to increase early presentation and shorten door-to-needle times in patients arriving within the golden hour.",
keywords = "acute care, acute stroke, acute therapy, emergency medical services, emergency medicine, stroke care, stroke delivery, therapy, thrombolysis, thrombolytic therapy",
author = "Saver, {Jeffrey L.} and Smith, {Eric E.} and Fonarow, {Gregg C.} and Reeves, {Mathew J.} and Xin Zhao and Olson, {Daiwai M.} and Schwamm, {Lee H.}",
year = "2010",
month = "7",
doi = "10.1161/STROKEAHA.110.583815",
language = "English (US)",
volume = "41",
pages = "1431--1439",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "7",

}

TY - JOUR

T1 - The "golden hour" and acute brain ischemia

T2 - Presenting features and lytic therapy in >30 000 patients arriving within 60 minutes of stroke onset

AU - Saver, Jeffrey L.

AU - Smith, Eric E.

AU - Fonarow, Gregg C.

AU - Reeves, Mathew J.

AU - Zhao, Xin

AU - Olson, Daiwai M.

AU - Schwamm, Lee H.

PY - 2010/7

Y1 - 2010/7

N2 - Background and purpose: The benefit of intravenous thrombolytic therapy in acute brain ischemia is strongly time dependent. Methods: The Get With the Guidelines-Stroke database was analyzed to characterize ischemic stroke patients arriving at hospital Emergency Departments within 60 minutes of the last known well time from April 1, 2003, to December 30, 2007. Results: During the 4.75-year study period, among 253 148 ischemic stroke patients arriving directly by ambulance or private vehicle at 905 hospital Emergency Departments, 106 924 (42.2%) had documented, exact last known well times. Onset to door time was ≤60 minutes in 30 220 (28.3%), 61 to 180 minutes in 33 858 (31.7%), and >180 minutes in 42 846 (40.1%). Features most strongly distinguishing the patients arriving at ≤60, 61 to 180, and >180 minutes were greater stroke severity (median National Institutes of Health Stroke Scale score, 8.0 vs 6.0 vs 4.0, P<0.0001) and more frequent arrival by ambulance (79.0%. vs 72.2% vs 55.0%, P<0.0001). Compared with patients arriving at 61 to 180 minute, "golden hour" patients received intravenous thrombolytic therapy more frequently (27.1% vs 12.9%; odds ratio=2.51; 95% CI, 2.41-2.61; P<0.0001), but door-to-needle time was longer (mean, 90.6 vs 76.7 minutes, P<0.0001). A door-to-needle time of ≤60 minutes was achieved in 18.3% of golden hour patients. Conclusions: At Get With the Guidelines-Stroke hospital Emergency Departments, more than one quarter of patients with documented onset time and at least one eighth of all ischemic stroke patients arrived within 1 hour of onset, where they received thrombolytic therapy more frequently but more slowly than late arrivers. These findings support public health initiates to increase early presentation and shorten door-to-needle times in patients arriving within the golden hour.

AB - Background and purpose: The benefit of intravenous thrombolytic therapy in acute brain ischemia is strongly time dependent. Methods: The Get With the Guidelines-Stroke database was analyzed to characterize ischemic stroke patients arriving at hospital Emergency Departments within 60 minutes of the last known well time from April 1, 2003, to December 30, 2007. Results: During the 4.75-year study period, among 253 148 ischemic stroke patients arriving directly by ambulance or private vehicle at 905 hospital Emergency Departments, 106 924 (42.2%) had documented, exact last known well times. Onset to door time was ≤60 minutes in 30 220 (28.3%), 61 to 180 minutes in 33 858 (31.7%), and >180 minutes in 42 846 (40.1%). Features most strongly distinguishing the patients arriving at ≤60, 61 to 180, and >180 minutes were greater stroke severity (median National Institutes of Health Stroke Scale score, 8.0 vs 6.0 vs 4.0, P<0.0001) and more frequent arrival by ambulance (79.0%. vs 72.2% vs 55.0%, P<0.0001). Compared with patients arriving at 61 to 180 minute, "golden hour" patients received intravenous thrombolytic therapy more frequently (27.1% vs 12.9%; odds ratio=2.51; 95% CI, 2.41-2.61; P<0.0001), but door-to-needle time was longer (mean, 90.6 vs 76.7 minutes, P<0.0001). A door-to-needle time of ≤60 minutes was achieved in 18.3% of golden hour patients. Conclusions: At Get With the Guidelines-Stroke hospital Emergency Departments, more than one quarter of patients with documented onset time and at least one eighth of all ischemic stroke patients arrived within 1 hour of onset, where they received thrombolytic therapy more frequently but more slowly than late arrivers. These findings support public health initiates to increase early presentation and shorten door-to-needle times in patients arriving within the golden hour.

KW - acute care

KW - acute stroke

KW - acute therapy

KW - emergency medical services

KW - emergency medicine

KW - stroke care

KW - stroke delivery

KW - therapy

KW - thrombolysis

KW - thrombolytic therapy

UR - http://www.scopus.com/inward/record.url?scp=77954174189&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77954174189&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.110.583815

DO - 10.1161/STROKEAHA.110.583815

M3 - Article

VL - 41

SP - 1431

EP - 1439

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 7

ER -