Ischemic stroke mortality and time for hospital arrival: analysis of the first 90 days.
Mariana de Almeida Moraes, Pedro Antônio Pereira de Jesus, Ludimila Santos Muniz and 6 others
PMID 37058593WHAT IT FOUND
Time to hospital arrival was not linked to death within 90 days overall.
In the small severe-stroke group, arrival time was linked, but the direction was unexpected. Atrial fibrillation and prior disability were clearer risks.
Key findings
01In the full adjusted model, arrival time was not associated with death.
02Atrial fibrillation was associated with higher death in the full adjusted model.
03The relationship between arrival time and death was modified by stroke severity.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was done in one public hospital in Bahia, so the sample may not represent other settings. Extra-hospital deaths were identified by telephone, and 9 participants were lost to follow-up. The stratified models were much smaller than the cohort: 237 in the full model, 166 in the NIHSS ≤13 model, and 71 in the NIHSS ≥14 model. The severe-stroke finding was in an unexpected direction and did not test arrival time as a treatment.
The easy way to misread this
Do not conclude that arriving at the hospital sooner prevents death. The full adjusted model did not show an association for arrival time, and the severe-stroke subgroup finding was small, observational, and in an unexpected direction.