Research ArticleOriginal Article
Open Access

Impact of implementing a stroke code on the door to needle time during Hajj at a tertiary center in Makkah, Saudi Arabia

Waleed M. Alzahrani, Afnan A. Sulaiman, Mohammed M. Babakkor, Ziad E. Aljundi, Hamad M. Alhilabi and Rawan A. Aldhahwani
Neurosciences Journal July 2023, 28 (3) 190-194; DOI: https://doi.org/10.17712/nsj.2023.3.20220141

Article Figures & Data

Tables

  • Table 1

    - Baseline characteristics.

    VariablesHajj (n=28)Non-Hajj (n=41)P-value
    n (%)
    Age
    Mean±SD64.2±10.563.3±15.5.695
    Median (IQR)64 (55–72.5)65 (55–75) 
    Gender
    Male19 (67.9)24 (58.5).433
    Female9 (32.1)17 (41.5) 
    Nationality
    Saudi5 (17.9)30 (73.2).000
    Non-Saudi23 (82.1)11 (26.8) 
    Risk factor
    None1 (3.6)0 (0).223
    Diabetes mellitus11 (39.3)25 (61).077
    Hypertension19 (67.9)35 (85.4).083
    IHD6 (21.4)16 (39).061
    CHF3 (10.7)8 (19.5).327
    Atrial fibrillation8 (28.6)5 (12.2).088
    Previous stroke12 (42.9)9 (22).064
    Hyper-lipidemia11 (39.3)10 (24.4).187
    Previous TIA1 (3.6)5 (12.2).212
    Smoking1 (3.6)2 (4.9).794
    Ex-smoking0 (0)2 (4.9).236
    Prosthetic mitral valve0 (0)1 (2.4).405
    Ischemic etiology
    Cardio-embolic11 (39.3)17 (41.5).533
    Large artery disease5 (17.9)11 (26.8) 
    Small artery disease5 (17.9)3 (7.3) 
    lacunar7 (25)10 (24.4) 
    Unknown   
  • Table 2

    - Stroke management parameters.

    VariableHajj (n=28)Non-Hajj (n=41)P-value
    Stroke onset to hospital arrival time (hours)
    Mean±SD2.2±.91.9±.9 
    Median (IQR)2 (2–3)2 (1–3).218
    Door to CT time (minutes)
    Mean±SD8.6±3.113.7±13.017
    Median (IQR)8 (7–10)10 (8–14.5) 
    DTN time (minutes)
    Mean±SD27.5±13.757.8±32.5.000
    Median (IQR)26.5 (15–35.7)60 (23.5–79.5) 
    Endovascular therapy performed10 (35.7%)8 (19.5%).132
    NIHSS at admission
    Mean±SD13.1±5.312.9±6.1.736
    Median (IQR)14 (8.2–17)12 (8.5–17.5) 

    • HT - Hemorrhagic Transformation, TPA - Tissue plasminogen activator, NIHSS -National Institutes of Health Stroke Scale, IQR - Interquartile Range

  • Table 3

    - Patients’ complications and outcomes.

    VariablesHajj (n=28) nNon-Hajj (n=41)P-value
    n (%)
    Hemorrhagic transformation (HT)7 (25)14 (34.1).417
    Time of HT post TPA (hours)
    Mean±SD19.8±9.931.6±20.204
    Median (IQR)16 (12–30)28 (15.5–40.5) 
    Clinical worsening after HT2 (7.1)5 (12.2).306
    Drop in NIHSS 4 points and more after HT2 (7.1)3 (7.3).717
    HT Type
    Hemorrhagic infarction2 (7.1)7 (17.1).481
    Parenchymal hematoma5 (17.9)7 (17.1) 
    Systemic hemorrhage post TPA0 (0)1 (2.4).405
    Recurrent stroke0 (0)5 (12.2).055
    Developed brain herniation5 (17.9)6 (14.6).720
    Decompressive craniectomy1 (3.6)2 (4.9).794
    NIHSS at discharge
    Mean±SD7.3±5.26.6±6.7.303
    Median (IQR)5 (3–12)5 (1–8.2) 
    Length of stay in hospital
    Mean±SD7.7±7.417±20.007
    Median (IQR)5 (3–10.2)10 (5–23) 

    • HT - Hemorrhagic Transformation, TPA - Tissue plasminogen activator, NIHSS -National Institutes of Health Stroke Scale, IQR - Interquartile Range

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