Delayed detection of in-hospital acute ischemic stroke: The impact of MRI and inpatient departments

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-09-08 DOI:10.1016/j.clineuro.2025.109151

Jun Karakama , Sakyo Hirai , Ryoichi Hanazawa , Masataka Yoshimura , Yohei Sato , Naoki Taira , Keigo Shigeta , Kana Sawada , Yoshihisa Kawano , Yoshiki Obata , Yosuke Ishii , Mariko Ishikawa , Mutsuya Hara , Motoshige Yamashina , Tadahiro Ishiwada , Hirotaka Sagawa , Satoru Takahashi , Hikaru Wakabayashi , Kyohei Fujita , Jiro Aoyama , Kazutaka Sumita

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Abstract

Objective

This study investigated the characteristics of in-hospital acute ischemic stroke (iHAIS) and factors associated with poor outcomes.

Methods

This retrospective, multicenter, observational cohort study included patients with pre-stroke modified Rankin Scale (mRS) 0–2 who underwent mechanical thrombectomy for iHAIS between April 2014 and August 2023. Focused on stroke detection to imaging (DTI) and stroke detection to groin puncture (DTP), we examined the association between these workflows and clinical outcomes and the factors associated with delayed DTI and DTP. Clinical outcomes were evaluated using the mRS at discharge, with mRS 3–6 defined as poor clinical outcomes.

Results

Overall, 110 (78.0 %) of 141 patients with iHAIS had poor clinical outcomes at discharge. Statistical analyses revealed that DTP tended to be associated with poor outcomes (odds ratio, 2.22 [95 % confidence interval (CI), 0.93–5.30], p = 0.072). Magnetic resonance imaging (MRI) diagnosis was associated with prolonged DTP (HR, 0.52 [95 % CI, 0.36–0.75], p = 0.001) and the hospitalization in the neurology or neurosurgery department tended to have prolonged DTP (HR, 0.61 [95 % CI, 0.38–1.01], p = 0.053).

Conclusions

In patients with iHAIS, MRI diagnosis and hospitalization in the neurology or neurosurgery department were associated with delayed DTP, which is linked to poor outcomes.

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住院急性缺血性脑卒中的延迟检测：MRI和住院科室的影响

目的探讨院内急性缺血性脑卒中（iHAIS）的特点及影响预后的相关因素。方法：这项回顾性、多中心、观察性队列研究纳入了2014年4月至2023年8月期间因iHAIS接受机械取栓的卒中前改良Rankin量表（mRS） 0-2患者。重点关注脑卒中检测到成像（DTI）和脑卒中检测到腹股沟穿刺（DTP），我们检查了这些工作流程与临床结果以及延迟DTI和DTP相关因素之间的关系。使用出院时的mRS评估临床结果，mRS 3-6定义为不良临床结果。结果141例iHAIS患者出院时临床预后较差110例（78.0 %）。统计分析显示，DTP倾向于与不良预后相关（优势比为2.22[95 %置信区间（CI）， 0.93-5.30], p = 0.072）。磁共振成像（MRI）诊断与DTP延长相关（HR, 0.52[95 % CI, 0.36-0.75], p = 0.001），神经内科或神经外科住院倾向于延长DTP （HR, 0.61[95 % CI, 0.38-1.01], p = 0.053）。结论在iHAIS患者中，MRI诊断和神经内科或神经外科住院与迟发性DTP相关，迟发性DTP与预后不良有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.