TY - JOUR
T1 - Time of day and endovascular treatment decision in acute stroke with relative endovascular treatment indication
T2 - insights from UNMASK EVT international survey
AU - Ospel, Johanna Maria
AU - Kashani, Nima
AU - Goyal, Mayank
AU - Menon, Bijoy K.
AU - Campbell, Bruce C.V.
AU - Fischer, Urs
AU - Turjman, Francis
AU - Mitchell, Peter
AU - Yoshimura, Shinichi
AU - Podlasek, Anna
AU - Rabinstein, Alejandro A.
AU - Wilson, Alexis T.
AU - Kim, Byung Moon
AU - Baxter, Blaise W.
AU - Cherian, Mathew P.
AU - Heo, Ji Hoe
AU - Foss, Mona
AU - Demchuk, Andrew M.
AU - Sylaja, Pillai N.
AU - Hill, Michael D.
AU - Saposnik, Gustavo
AU - Almekhlafi, Mohammed A.
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2020/2/1
Y1 - 2020/2/1
N2 - Background and purpose The decision to proceed with endovascular thrombectomy should ideally be made independent of inconvenience factors, such as daytime. We assessed the influence of patient presentation time on endovascular therapy decision making under current local resources and assumed ideal conditions in acute ischemic stroke with level 2B evidence for endovascular treatment. Methods and materials In an international cross sectional survey, 607 stroke physicians from 38 countries were asked to give their treatment decisions to 10 out of 22 randomly assigned case scenarios. Eleven scenarios had level 2B evidence for endovascular treatment: 7 daytime scenarios (7:00 am-5:00 pm) and four night time cases (5:01 pm- 6:59 am). Participants provided their treatment approach assuming (A) there were no practice constraints and (B) under their current local resources. Endovascular treatment decisions in the 11 scenarios were analyzed according to presentation time with adjustment for patient and physician characteristics. Results Participants selected endovascular therapy in 74.2% under assumed ideal conditions, and 70.7% under their current local resources of night time scenarios, and in 67.2% and 63.8% of daytime scenarios. Night time presentation did not increase the probability of a treatment decision against endovascular therapy under current local resources or assumed ideal conditions. Conclusion Presentation time did not influence endovascular treatment decision making in stroke patients in this international survey.
AB - Background and purpose The decision to proceed with endovascular thrombectomy should ideally be made independent of inconvenience factors, such as daytime. We assessed the influence of patient presentation time on endovascular therapy decision making under current local resources and assumed ideal conditions in acute ischemic stroke with level 2B evidence for endovascular treatment. Methods and materials In an international cross sectional survey, 607 stroke physicians from 38 countries were asked to give their treatment decisions to 10 out of 22 randomly assigned case scenarios. Eleven scenarios had level 2B evidence for endovascular treatment: 7 daytime scenarios (7:00 am-5:00 pm) and four night time cases (5:01 pm- 6:59 am). Participants provided their treatment approach assuming (A) there were no practice constraints and (B) under their current local resources. Endovascular treatment decisions in the 11 scenarios were analyzed according to presentation time with adjustment for patient and physician characteristics. Results Participants selected endovascular therapy in 74.2% under assumed ideal conditions, and 70.7% under their current local resources of night time scenarios, and in 67.2% and 63.8% of daytime scenarios. Night time presentation did not increase the probability of a treatment decision against endovascular therapy under current local resources or assumed ideal conditions. Conclusion Presentation time did not influence endovascular treatment decision making in stroke patients in this international survey.
UR - http://www.scopus.com/inward/record.url?scp=85068852043&partnerID=8YFLogxK
U2 - 10.1136/neurintsurg-2019-014976
DO - 10.1136/neurintsurg-2019-014976
M3 - Article
C2 - 31285376
AN - SCOPUS:85068852043
SN - 1759-8478
VL - 12
SP - 122
EP - 126
JO - Journal of Neurointerventional Surgery
JF - Journal of Neurointerventional Surgery
IS - 2
ER -