Prehospital notification reduced time delays but not neurological outcomes in acute ischemic stroke

Prehospital notification reduced time delays but not neurological outcomes in acute ischemic stroke | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prehospital notification reduced time delays but not neurological outcomes in acute ischemic stroke Azra Sangari, Kobra Akhoundzadeh, Mostafa Vahedian This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-440192/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Since timely thrombolytic therapy is a crucial variable in acute ischemic stroke recovery, health care systems are trying to find new interventions to reduce treatment delay in order to improve neurological function. In Iran, SAMA code as a prehospital notification plan has been developed to help emergent stroke treatment. This study aimed to compare time delay to thrombolysis therapy and neurological outcomes between prehospital notification (SAMA)-transported patients and self-transported patients in acute ischemic stroke. Methods and materials: In this retrospective cohort study, the data of 185 stroke patients treated with intravenous thrombolysis were gathered. There were two groups including, SAMA-transported (n=110) patients and self-transported (n=75) patients. The treatment delays including, onset to needle time (ONT), onset to door time, (ODT), door to CT time (DCT) and door to needle time (DNT) as well the neurological scores measured using NIHSS and mRS were analyzed between two groups. p-value<0.05 was considered as significant. Results: The results showed that delay times reduced in SAMA-transported patient compared to that in self-transported patients. The findings revealed a significant difference in ONT (150 (120-180) vs 180 (150-225) (p=0.001), DNT (80 (60-105) vs 100 (80-125) (p=0.0001), and DCT (27 (20-37) vs 36 (24-52) (p=0.001) between SAMA-transported patients and self-transported patients. The times are represented as minute (median and IQR). However, there was no significant difference between two groups in terms of neurologic deficit severity . Also, there was no relationship between the delay time and neurological outcomes. Conclusion: Although SAMA prehospital notification could partially reduce treatment delay times in acute ischemic stroke, such reduction was not enough to impact on neurologic deficit recovery. It seems more reduction in delay time is needed to significant improvement of neurological dysfunctions. Neurology delay time thrombolysis therapy neurological outcome prehospital notification ischemic stroke Introduction Stroke is still the second leading cause of death and a main cause of long-term disability around the world. That imposes serious economic and social problems on patient, family and public health ( 1 ). Approximately 80% of strokes are classified as ischemic stroke ( 2 ) and the intravenous thrombolysis is a well-known and widely-used therapy for this type of stroke. However, this treatment is time dependent and delay in thrombolysis injection reduces its effectiveness. Consequently timely intravenous thrombolysis for acute ischemic stroke is a main concern in health care system ( 3 ). The phrase “time is brain” emphasizes on emergency treatment of stroke ( 4 ), Therefore, health care systems have been trying to plan and stabilize some interventions in order to reduce delay for thrombolytic therapy. One of these activities to reduce treatment delay is stabilization of prehospital notification. Prehospital notification for stroke in Iran, coded as SAMA, aims to reduce the treatment delay by rapidly identifying stroke-suspected patients who are positive in face, arm and speech tests (FAST), and by quickly transporting that patients to the comprehensive stroke centers, as well as by increasing alertness and readiness of the stroke centers for immediate treatment ( 5 ). The principal purpose in the treatment of stroke patients is to improve neurological deficits ( 6 ). Therefore, the success of any intervention and treatment in stroke, such as SAMA prehospital notification is mainly measured by its effect on neurological improvement. With regard to importance of reduction of delay in thrombolytic therapy and importance of neurological improvement as the main concern for stroke treatment, this study was done to assess whether SAMA prehospital notification has a proper performance to reduce treatment delay and, if so, whether that amount of time reduction could have significant effect on neurological outcomes. Therefore, this study aimed to compare time delay and neurological outcomes between prehospital notification (SAMA)-transported patients and self-transported patients in acute ischemic stroke. Methods And Materials In this retrospective cohort study, data were obtained from the files of the acute ischemic stroke patients treated with intravenous rtPA thrombolysis. This study was done in Shahid Beheshti hospital affiliated to Qom university of medical sciences, Iran. This hospital as a 724 code hospital has been equipped with a stroke center providing specific care for acute ischemic stroke patients. Also SAMA code as a prehospital notification service has been established in order to quick transport of patients with a suspected stroke to 724 code hospital ( 5 ). As a whole, 724 code hospital and prehospital notification (SAMA) code were developed to rapidly identify and treat patients suspected to acute ischemic stroke. The study was approved by Iran national committee for ethics in biomedical research (record no. IR.MUQ.REC.1398.022). All methods were performed in accordance with the relevant guidelines and regulations. Acute ischemic stroke patients between 18 to 80 years old who received thrombolytic drug and had complete hospital records, were included in the study from Mar 2016 to May 2020. Excluded files were the file of patients diagnosed with hemorrhagic stroke or not treated with thrombolysis. Also, patients who died or had bleeding or severe complications were excluded. A total of 185 eligible patients who received thrombolytic therapy, 110 patients transported through SAMA code and 75 patients presented to hospital by themselves, were included in the study. The collected data included the demographic and comorbidities data, neurological assessment using NIHSS and mRS at admission and discharge and the times including Onset to Door time (ODT), Onset to Needle time (ONT), Door to Needle Time (DNT) and Door to CT Time (DCT). Statistical analysis Quantitative data were presented as median (interquartile range, IQR) or mean ± standard deviation and qualitative data were presented as frequency and percentages. After testing for normality, the groups were compared using Mann-Whitney U test or χ 2 tests. Also relationship between two groups in term of neurological outcomes or time delay was tested using Spearman's test. Data were analyzed using SPSS software version 22. P value < 0.05 was considered statistically significant. Results Demographic characteristics and comorbidities are shown in table 1. Findings of the treatment times, presented in table. 2, showed that ODT in the SAMA-transported patients (60 (40-88)) was not significantly different in comparison with that in the self-transported patients (65 (40-115) (p=0.22). However, the results displayed the significant difference between SAMA-transported patients and self-transported patients in terms of DNT (80 (60-105) vs 100 (80-125) (p<0.0001) and DCT (27 (20-37) vs 36 (24-52) (p<0.001). Also ONT in SAMA-transported patients were significantly shortened in comparison with the self-transported patients (150 (120-180) vs 180 (150-225, p<0.001) (tab. 2). The results of neurologic deficit severity scales are presented in table 3. The results showed that the admission neurologic deficit severity, assessed using NIHSS, was not different between two groups (15 (10-18) vs. 13 (10-16), p=0.17). Also, there was no significant NIHSS difference at discharge time between the SAMA-transported patients and the self-transported patients (1 (0-5) vs 1 (0-4.25), p=0.97). Analysis of data of mRS as another neurologic disability scale showed similar results. There was no significant difference between the SAMA-transported and the self-transported patients in mRS score at admission time (5 (4-5) vs 4 (3-5) p=0.07) and discharge time (1 (0-3) vs 1 (0-1) p = 0.30) (tab.3). The Findings of the neurological deficit improvement in SAMA-transported patients and self-transported patients are shown in table 4. As shown in table 4 there was no significant difference in the amount of improvement between two groups. Table 5 and 6 presents the results of correlation between the delay times and the improvement in neurologic function in two groups. No relationship was shown between times (ONT, ODT, DCT, DNT) and improvement in HINSS or mRS (tab. 6). Discussion Stroke is still a main cause of long-term disability and mortality as well is one of the main challenges in health care systems around the world ( 1 ). Nowadays the known treatment for acute ischemic stroke is intravenous thrombolysis. However, this treatment is time dependent. Regarding to importance of early administration of thrombolysis as well as the importance of neurological recovery as the final purpose of stroke treatment, this study aimed to compare time delay and neurological outcomes between the prehospital notification (SAMA)-transported patients and self-transported patients in acute ischemic stroke. According to present findings, time delays, including onset to needle time, door to CT time and door to needle time were shorter in SAMA-transported patients in comparison to that in self-transported patients. These findings were similar to Sadeghi-Hokmabadi and colleagues’ study that showed the prehospital notification can significantly reduce treatment delays including door-to-CT and door-to-needle times in acute ischemic stroke patients ( 7 , 8 ) .Moreover, there are a number of studies in various countries with comparable results ( 9-13 ). In general, it is shown that the prehospital notification in different regions has had an acceptable performance in reducing time delay of thrombolytic therapy in acute ischemic stroke patients. Therefore, stabilization of SAMA code as a prehospital notification system succeeded to achieve goal of early transportation of ischemic stroke patient. Although the reduction of delay time is a significant point in the stabilization of prehospital notifications for stroke, the final goal of implementation of any new intervention, such as prehospital notification is to improve neurologic deficit. Because of importance of neurologic outcomes in stroke treatment, current study aimed to assess the effect of SAMA prehospital notification on neurologic function measured using NIHSS and mRS in patients received thrombolytic drug. According to our results, there was no significant difference between the SAMA-transported and the Self-transported patients in neurological outcomes assessed by NIHSS and mRS at discharge time. Lack of a significant difference in neurological improvement between two groups in spite of reduction of delay time was an unexpected finding. However, Similar to current results, some studies didn’t show the significant effect of reduction of delay time on neurological outcomes in ischemic stroke patients. For example, Kim and colleagues' study in Korea showed that prehospital notification, in spite of reduction in the in-hospital processing times, could not have a significant effect on neurological outcome improvement in acute ischemic stroke patients treated with thrombolysis. Same as our study, this study used NIHSS and mRS neurologic scales to measure neurological deficits ( 14 ). Also, there are some similar studies showed that the reduction of the interval time did not lead to better outcomes on mRS or NIHSS in acute stroke patients ( 9 , 15 , 16 ). In Sohn and colleagues’ study, there were different findings on MRI and CT groups. In MRI- based thrombolysis group the reduction of time intervals coincided with significant improvement in favorable outcomes while in CT- based thrombolysis group in spite of reduction of delay, there was no significant increase in favorable outcomes ( 17 ). There are some explanations or assumptions for lack of functional improvement in spite of a reduction in delay time. That may be due to the scale that is used to assess neurological improvement. It is probable that some scales are not able to assess slight improvement in neurological deficits. Also, assessment time might be a cause of diversity of results of functional improvement. For example, as studies of Mohamad and colleagues ( 18 ) and Candelaresi and colleagues showed ( 19 ), assessment of neurological function by the modified Rankin Scale (mRS) after a long term such as 90-day post stroke may show better finding, while assessment at a short time after stroke may show no difference between groups ( 16 ). Although in our study, onset to needle time reduced by 32 min in the prehospital notification (SAMA) -transported patients in comparison to self-transported patients, it did not coincide with better neurological function. The authors presume that in order to make a statistically significant difference in neurological function between groups, more marked reduction in delay is needed to be made. Another assumption for diversity in results is that the real onset of stroke might be different from what is reported in patient documents. We thought that some patients might ignore mild signs for a while and call for a help when signs are getting worse. Therefore, some patients might lose the golden time for receiving thrombolysis before transport to hospital. There were some limitations to this study. Assessment of NIHSS and mRS by various assessors may result in measurement errors. Since just one hospital in Qom city is equipped to stroke center and number of admitted patients was partly small, sample size was another limitation. Larger sample size might increase the power of tests. Conclusion Finding of this study showed that performance of SAMA prehospital notification in reduction of treatment delay in acute ischemic strokes was acceptable to some extent. However, such amount of time reduction didn’t have significant effect on neurological deficit improvement. According to evidences, time is a determining factor in the effectiveness of thrombolytic therapy in acute ischemic strokes therefore stabilization of prehospital notification plans, such as SAMA code, in order to reduce delay time could likely be advantageous to decrease ischemic stroke complications. However, it is probable that more markedly reduction in delay time is needed for improvement of neurological dysfunctions. Declarations Ethics approval and consent to participate This work approved by Iran national committee for ethics in biomedical research (record no. IR.MUQ.REC.1398.022) was supported by Qom University of medical science, Qom, Iran. The article was extracted from the MSc. student thesis of Azra Sangari. The consent to participate was waived due to retrospective study Consent for publication Not applicable Availability of data and materials’ statement The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request Competing interest No potential conflict of interest was reported by the authors. Funding . No funding to declare Authors' contributions KA wrote the main manuscript text, AS gathered data and drafted the manuscript, and MV analyzed the data. All authors reviewed the manuscript. Acknowledgment The authors would like to express their deepest gratitude to Dr. Sharifipour and Dr. Momenian for their helpful advices and supports. We would like to thank the staffs on Shahid beheshti hospital of Qom University of Medical Sciences for providing facilities for this work. References .1 Donkor ES. Stroke in the century: a snapshot of the burden, epidemiology, and quality of life. Stroke research and treatment. 2018;2018. https://doi.org/10.1155/2018/3238165 . .2 Ghandehari K. Epidemiology of stroke in Iran. Galen Medical Journal. 2016 ;5( S1):3-9. http://irisweb.ir/files/site1/rds_journals/257/article-257-376305.pdf . .3 Sharobeam A, Jones B, Walton-Sonda D, Lueck CJ. Factors delaying intravenous thrombolytic therapy in acute ischaemic stroke: A systematic review of the literature. Journal of neurology. 2020:1-12. https://doi.org/10.1007/s00415-020-09803-6 . .4 Saver JL. Time is brain—quantified. Stroke. 2006;37(1):263-6. https://doi.org/10.1161/01.STR.0000196957.55928.ab . .5 Kolivand P-H, Faraji Sabokbar H, Saberian P, Bahmanabadi M, Hasani-Sharamin P, Baratloo A. Spatial Analysis of Geographic Distribution and Accessibility of Suspected Acute Stroke Patients Transferred to Acute Stroke Centers by Emergency Medical Services in Tehran, Iran: A Cross-Sectional Study. Iranian Red Crescent Medical Journal.22(7 ). .6 Schaar KL, Brenneman MM, Savitz SI. Functional assessments in the rodent stroke model. Experimental & translational stroke medicine. 2010;2(1):1-11. https://doi.org/10.1186/2040-7378-2-13 . .7 Sadeghi-Hokmabadi E, Yazdchi M, Farhoudi M, Sadeghi H, Taheraghdam A, Rikhtegar R, et al. Prognostic factors in patients with acute ischemic stroke treated with intravenous tissue plasminogen activator: the first study among Iranian patients. Iranian journal of neurology. 2018;17(1):31 . .8 Sadeghi-Hokmabadi E, Taheraghdam A, Hashemilar M, Rikhtegar R, Mehrvar K, Mehrara M, et al. Simple in-hospital interventions to reduce door-to-CT time in acute stroke. International journal of vascular medicine. 2016;2016 . .9 Tan BY, Ngiam NJ, Sunny S, Kong WY, Tam H, Sim TB, et al. Improvement in door-to-needle time in patients with acute ischemic stroke via a simple stroke activation protocol. Journal of Stroke and Cerebrovascular Diseases. 2018;27(6):1539-45. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.01.005 . .10 Hsieh M-J, Tang S-C, Chiang W-C, Tsai L-K, Jeng J-S, Ma MH-M. Effect of prehospital notification on acute stroke care: a multicenter study. Scandinavian journal of trauma, resuscitation and emergency medicine. 2016;24(1):57. https :// doi.org/10.1186/s13049-016-0251-2 . .11 Kim D-H, Nah H-W, Park H-S, Choi J-H, Kang M-J, Huh J-T, et al. Impact of prehospital intervention on delay time to thrombolytic therapy in a stroke center with a systemized stroke code program. Journal of Stroke and Cerebrovascular Diseases. 2016;25(7):1665-70. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.02.011 . .12 Arrate AO, Guerrero MF, Maiztegi CF, Calle IA, Fernández RS, Rodríguez MF, et al. Use of emergency medical transport and impact on time to care in patients with ischaemic stroke. Neurología (English Edition). 2019;34(2):80-8. https://doi.org/10.1016/j.nrleng.2016.11.003 . .13 Lindsberg PJ, Häppölä O, Kallela M, Valanne L, Kuisma M, Kaste M. Door to thrombolysis: ER reorganization and reduced delays to acute stroke treatment. Neurology. 2006;67(2):334-6 . .14 Kim S, Lee S, Bae H-J, Lee YS, Kim S, Kang M, et al. Pre‐hospital notification reduced the door‐to‐needle time for IV t‐PA in acute ischaemic stroke. European Journal of Neurology. 2009;16(12 ):1331-5. https://doi.org/10.1111/j.1468-1331.2009.02762.x . .15 Heo JH, Kim YD, Nam HS, Hong K-s, Ahn SH, Cho HJ, et al. A computerized in-hospital alert system for thrombolysis in acute stroke. Stroke. 2010;41(9):1978-83. https://doi.org/10.1161/STROKEAHA .110.583591. .16 Bhatt N, Marulanda-Londoño ET, Atchaneeyasakul K, Malik AM, Asdaghi N, Akram N, et al. Target stroke: Best practice strategies cut door to thrombolysis time to< 30 minutes in a large urban academic comprehensive stroke center. The Neurohospitalist. 2019;9(1):22-5. https://doi.org/10.1177%2F1941874418801443 . .17 Sohn S-W, Park H-S, Cha J-K, Nah H-W, Kim D-H, Kang M-J, et al. A systemized stroke code significantly reduced time intervals for using intravenous tissue plasminogen activator under magnetic resonance imaging screening. Journal of Stroke and Cerebrovascular Diseases. 2015;24(2):465-72. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.09.020 . .18 Mohamad NF, Hastrup S, Rasmussen M, Andersen MS, Johnsen SP, Andersen G, et al. Bypassing primary stroke centre reduces delay and improves outcomes for patients with large vessel occlusion. European Stroke Journal. 2016;1(2):85-92. https://doi.org/10.1177/2396987316647857 . .19 Candelaresi P, Lattuada P, Uggetti C, Daccò R, Fontana G, Frediani F. A high-urgency stroke code reduces in-hospital delays in acute ischemic stroke: a single-centre experience. Neurological Sciences. 2017;38(9):1671-6. https://doi.org/10.1007/s10072-017-3046-y . Tables Tab. 1 Demographics characteristics and comorbidities between SAMA-transported and self-transported patients P value self-transported N=75 SAMA-transported N=110 Variable 0.50 64 65 Age (Mean±SD) 0.79 56% men 53% men Gender % 1* 98% married 98% married Marital status% 0.03 19 8 past history of stroke % 0.99 7 6 past history of TIA % 0.39 21 27 Past History of Heart Disease % 1* 3 2 Smoking % 1* 0 0.009 Addiction % 0.38 52 45 Hypertensions % 0.11 35 24 Diabetes % 0.78 12 11 Dyslipidemia % Tab. 2 Comparison of delay times between SAMA-transported and self-transported patients P value Median (IQR) min Group Variable 0.001 180 (150-225) Self –transported ONT 150 (120-180) SAMA-transported 0.22 65 (40-115) Self –transported ODT 60 (40-88) SAMA-transported 0.0001 100 (80-125) Self –transported DNT 80 (60-105) SAMA-transported 0.001 36 (24-52) Self –transported DCT 27 (20-37) SAMA-transported Tab. 3 Comparison of neurological deficit improvement between SAMA-transported and self-transported patients P value Median ( (IQR) Group Variable 0.17 13 (10-16) Self –transported Admission NIHSS 15 (10-18) SAMA-transported 0.97 1 (0-4.25) Self –transported Discharge NIHSS 1 (0-5) SAMA-transported 0.07 4 (3-5) Self –transported Admission mRS 5 (4-5) SAMA-transported 0.30 1 (0-1) Self –transported Discharge mRS 1 (0-3) SAMA-transported Tab. 4 Comparison of neurological deficit improvement in SAMA-transported and self-transported patients P value Median (IQR) min Group Variable 0.22 10 (8-13) Self –transported neurological deficit improvement on NIHSS 11 (7-15) SAMA-transported 0.89 3 (2-4) Self –transported neurological deficit improvement on mRS 3 (2-4) SAMA-transported Tab. 5 Correlation between neurological deficit severity measured by NIHSS and delay times P value correlation coefficient r Group Variable 0.53 0.08 Self –transported ONT 0.80 -0.03 SAMA-transported 0.74 0.025 All patients 0.05 0.24 Self –transported ODT 0.72 -0.04 SAMA-transported 0.30 0.08 All patients 0.35 0.11 - Self –transported DNT 0.50 0.07 - SAMA-transported 0.11 0.013 All patients 0.14 0.19 - Self –transported DCT 0.14 0.15 SAMA-transported 0.90 0.010 All patients Tab. 6 Correlation between neurological deficit improvement measured by mRS and delay times P value correlation coefficient r Group Variable 0.63 0.06 Self –transported ONT 0.89 0.14 - SAMA-transported 0.95 0.05 All patients 0.26 0.14 Self –transported ODT 0.86 0.02 - SAMA-transported 0.56 0.04 All patients 0.41 -0.10 Self –transported DNT 0.68 0.04 SAMA-transported 0.90 0.01 - All patients 0.32 0.13 - Self –transported DCT 0.30 0.10 SAMA-transported 0.89 0.01 - All patients Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-440192","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":23528689,"identity":"953ef2a4-b7eb-44d6-9edc-a35f580bafd8","order_by":0,"name":"Azra Sangari","email":"","orcid":"","institution":"Qom University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Azra","middleName":"","lastName":"Sangari","suffix":""},{"id":23528690,"identity":"068ad92e-4d49-491b-b21f-68538a9bae5c","order_by":1,"name":"Kobra Akhoundzadeh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYFACHgaGDxX/6vtB7IQCIrUwzjhzgHFmA0iLAZFamHnbDjBuOADiEKNFt7332AcetjvMxudXJ354YMAgzy92AL8WszPnkmdI8DxjM7vxdrME0GGGM2cnENByI8eYwUCCmcfsxtkNIC0JBrcJabn/xhiojFnCeMbZzT+I03KDx5jhQMJhAwP+3m1E2nImx5ix4UBagsQN3m0WCQYSRPjl+Blj5r//bBL4+89uvvmjwkaeX5qAFgSQAKuUIFY5CPAfIEX1KBgFo2AUjCQAAJBhRzTldaHAAAAAAElFTkSuQmCC","orcid":"","institution":"Qom University of Medical Sciences","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Kobra","middleName":"","lastName":"Akhoundzadeh","suffix":""},{"id":23528691,"identity":"49471b29-7971-4edb-afdd-077fa5cb191e","order_by":2,"name":"Mostafa Vahedian","email":"","orcid":"","institution":"Qom University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mostafa","middleName":"","lastName":"Vahedian","suffix":""}],"badges":[],"createdAt":"2021-04-19 13:29:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-440192/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-440192/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13689686,"identity":"c5baa1bc-d12d-4ebd-a63d-c037a1325214","added_by":"auto","created_at":"2021-09-17 12:30:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":281962,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-440192/v1/11691e5a-654d-4650-a65f-17869e408353.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prehospital notification reduced time delays but not neurological outcomes in acute ischemic stroke","fulltext":[{"header":"Introduction","content":"\u003cp\u003eStroke is still the second leading cause of death and a main cause of long-term disability around the world. That imposes serious economic and social problems on patient, family and public health (\u003ca href=\"#_ENREF_1\"\u003e1\u003c/a\u003e). Approximately 80% of strokes are classified as\u0026nbsp;ischemic\u0026nbsp;stroke (\u003ca href=\"#_ENREF_2\"\u003e2\u003c/a\u003e) and the\u0026nbsp; intravenous thrombolysis is a well-known and widely-used therapy for this type of stroke.\u0026nbsp; However, this treatment is time dependent and delay in thrombolysis injection reduces its effectiveness. Consequently timely intravenous thrombolysis for acute ischemic stroke is a main concern in health care system (\u003ca href=\"#_ENREF_3\"\u003e3\u003c/a\u003e).\u003c/p\u003e\n\u003cp\u003eThe phrase \u0026ldquo;time is brain\u0026rdquo; emphasizes on emergency treatment of stroke (\u003ca href=\"#_ENREF_4\"\u003e4\u003c/a\u003e), Therefore, health care systems have been trying to plan and stabilize some interventions in order to reduce delay for thrombolytic therapy. One of these activities to reduce treatment delay is stabilization of prehospital notification.\u0026nbsp; Prehospital notification for stroke in Iran, coded as SAMA, aims to reduce the treatment delay by rapidly identifying stroke-suspected patients who are positive in face, arm and speech tests (FAST), and by quickly transporting that patients to the comprehensive stroke centers, as well as by increasing alertness and readiness of the stroke centers for immediate treatment (\u003ca href=\"#_ENREF_5\"\u003e5\u003c/a\u003e).\u003c/p\u003e\n\u003cp\u003eThe principal purpose in the treatment of stroke patients is to improve neurological deficits (\u003ca href=\"#_ENREF_6\"\u003e6\u003c/a\u003e). Therefore, the success of any intervention and treatment in stroke, such as SAMA prehospital notification is mainly measured by its effect on neurological improvement. With regard to importance of reduction of delay in thrombolytic therapy and importance of neurological improvement as the main concern for stroke treatment, this study was done to assess whether SAMA prehospital notification has a proper performance to reduce treatment delay and, if so, whether that amount of time reduction could have significant effect on neurological outcomes. Therefore, this study aimed to compare time delay and neurological outcomes between prehospital notification (SAMA)-transported patients and self-transported patients in acute ischemic stroke.\u003c/p\u003e"},{"header":"Methods And Materials","content":"\u003cp\u003e\u0026nbsp;In this retrospective cohort study, data were obtained from the files of the acute ischemic stroke patients treated with intravenous rtPA thrombolysis. This study was done in Shahid Beheshti hospital affiliated to Qom university of medical sciences, Iran. This hospital as a 724 code hospital has been equipped with a stroke center providing specific care for acute ischemic stroke patients. Also SAMA code as a prehospital notification service has been established in order to quick transport of patients with a suspected stroke to 724 code hospital (\u003ca href=\"#_ENREF_5\"\u003e5\u003c/a\u003e). As a whole, 724 code hospital and prehospital notification (SAMA) code were developed to rapidly identify and treat patients suspected to acute ischemic stroke.\u003c/p\u003e\n\u003cp\u003eThe study was approved by Iran national committee for ethics in biomedical research (record no. IR.MUQ.REC.1398.022). All methods were performed in accordance with the relevant guidelines and regulations. Acute ischemic stroke patients between 18 to 80 years old who received thrombolytic drug and had complete hospital records, were included in the study from Mar 2016 to May 2020.\u003c/p\u003e\n\u003cp\u003eExcluded files were the file of patients diagnosed with hemorrhagic stroke or not treated with thrombolysis. Also, patients who died or had bleeding or severe complications were excluded. A total of 185 eligible patients who received thrombolytic therapy, 110 patients transported through SAMA code and 75 patients presented to hospital by themselves, were included in the study.\u003c/p\u003e\n\u003cp\u003eThe collected data included the demographic and comorbidities data, neurological assessment using NIHSS and mRS at admission and discharge and the times including Onset to Door time (ODT), Onset to Needle time (ONT), Door to Needle Time (DNT) and Door to CT Time (DCT).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQuantitative data were presented as median (interquartile range, IQR) or mean \u0026plusmn; standard deviation and qualitative data were presented as frequency and percentages. After testing for normality, the groups were compared using Mann-Whitney U test or \u0026chi; 2 tests. Also relationship between two groups in term of neurological outcomes or time delay was tested using Spearman's test. Data were analyzed using SPSS software version 22.\u0026nbsp; P value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDemographic characteristics and comorbidities are shown in table 1. Findings of the treatment times, presented in table. 2, showed that ODT in the SAMA-transported patients (60 (40-88)) was not significantly different in comparison with that in the self-transported patients (65 (40-115) (p=0.22). However, the results displayed the significant difference between SAMA-transported patients and self-transported patients in terms of DNT (80 (60-105) vs 100 (80-125) (p\u0026lt;0.0001) and DCT (27 (20-37) vs 36 (24-52) (p\u0026lt;0.001). Also ONT in SAMA-transported patients were significantly shortened in comparison with the self-transported patients (150 (120-180) vs 180 (150-225, p\u0026lt;0.001) (tab. 2).\u0026nbsp;\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe results of neurologic deficit severity scales are presented in table 3. The results showed that the admission neurologic deficit severity, assessed using NIHSS, was not different between two groups (15 (10-18) vs. 13 (10-16), p=0.17). Also, there was no significant NIHSS difference at discharge time between the SAMA-transported patients and the self-transported patients (1 (0-5) vs 1 (0-4.25), p=0.97). Analysis of data of mRS as another neurologic disability scale showed similar results. There was no significant difference between the SAMA-transported and the self-transported patients in mRS score at admission time (5 (4-5) vs 4 (3-5) p=0.07) and discharge time (1 (0-3) vs 1 (0-1) p = 0.30) (tab.3).\u003c/p\u003e\n\u003cp\u003eThe Findings of the neurological deficit improvement in SAMA-transported patients and self-transported patients are shown in table 4. As shown in table 4 there was no significant difference in the amount of improvement between two groups. Table 5 and 6 presents the results of correlation between the delay times and the improvement in neurologic function in two groups. No relationship was shown between times (ONT, ODT, DCT, DNT) and improvement in HINSS or mRS (tab. 6).\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eStroke is still a main cause of long-term disability and mortality as well is one of the main challenges in health care systems around the world (\u003ca href=\"#_ENREF_1\"\u003e1\u003c/a\u003e). Nowadays the known treatment for acute ischemic stroke is intravenous thrombolysis. However, this treatment is time dependent. Regarding to importance of early administration of thrombolysis as well as the importance of neurological recovery as the final purpose of stroke treatment, this study aimed to compare time delay and neurological outcomes between the prehospital notification (SAMA)-transported patients and self-transported patients in acute ischemic stroke.\u003c/p\u003e\n\u003cp\u003eAccording to present findings, time delays, including onset to needle time, door to CT time and door to needle time were shorter in SAMA-transported patients in comparison to that in self-transported patients. These findings were similar to Sadeghi-Hokmabadi and colleagues\u0026rsquo; study that showed the prehospital notification can significantly reduce treatment delays including door-to-CT and door-to-needle times in acute ischemic stroke patients (\u003ca href=\"#_ENREF_7\"\u003e7\u003c/a\u003e, \u003ca href=\"#_ENREF_8\"\u003e8\u003c/a\u003e) .Moreover, there are a number of studies in various countries with comparable results (\u003ca href=\"#_ENREF_9\"\u003e9-13\u003c/a\u003e). In general, it is shown that the prehospital notification in different regions has had an acceptable performance in reducing time delay of thrombolytic therapy in acute ischemic stroke patients. Therefore, stabilization of SAMA code as a prehospital notification system succeeded to achieve goal of early transportation of ischemic stroke patient.\u003c/p\u003e\n\u003cp\u003eAlthough the reduction of delay time is a significant point in the stabilization of prehospital notifications for stroke, the final goal of implementation of any new intervention, such as prehospital notification is to improve neurologic deficit. Because of importance of neurologic outcomes in stroke treatment, current study aimed to assess the effect of SAMA prehospital notification on neurologic function measured using NIHSS and mRS in patients received thrombolytic drug. According to our results, there was no significant difference between the SAMA-transported and the Self-transported patients in neurological outcomes assessed by NIHSS and mRS at discharge time. Lack of a significant difference in neurological improvement between two groups in spite of reduction of delay time was an unexpected finding. However, Similar to current results, some studies didn\u0026rsquo;t show the significant effect of reduction of delay time on neurological outcomes in ischemic stroke patients. For example, Kim and colleagues' study in Korea showed that prehospital notification, in spite of reduction in the in-hospital processing times, could not have a significant effect on neurological outcome improvement in acute ischemic stroke patients treated with thrombolysis. Same as our study, this study used NIHSS and mRS neurologic scales to measure neurological deficits (\u003ca href=\"#_ENREF_14\"\u003e14\u003c/a\u003e). Also, there are some similar studies showed that the reduction of the interval time did not lead to better outcomes on mRS or NIHSS in acute stroke patients (\u003ca href=\"#_ENREF_9\"\u003e9\u003c/a\u003e, \u003ca href=\"#_ENREF_15\"\u003e15\u003c/a\u003e, \u003ca href=\"#_ENREF_16\"\u003e16\u003c/a\u003e). In Sohn and colleagues\u0026rsquo; study, there were different findings on MRI and CT groups. In MRI- based thrombolysis group the reduction of time intervals coincided with significant improvement in favorable outcomes while in CT- based thrombolysis group in spite of reduction of delay, there was no significant increase in favorable outcomes (\u003ca href=\"#_ENREF_17\"\u003e17\u003c/a\u003e).\u003c/p\u003e\n\u003cp\u003eThere are some explanations or assumptions for lack of functional improvement in spite of a reduction in delay time. That may be due to the scale that is used to assess neurological improvement. It is probable that some scales are not able to assess slight improvement in neurological deficits. Also, assessment time might be a cause of diversity of results of functional improvement. For example, as studies of Mohamad and colleagues (\u003ca href=\"#_ENREF_18\"\u003e18\u003c/a\u003e) and Candelaresi and colleagues showed (\u003ca href=\"#_ENREF_19\"\u003e19\u003c/a\u003e), assessment of neurological function by the modified Rankin Scale (mRS) after a long term such as 90-day post stroke may show better finding, while assessment at a short time after stroke may show no difference between groups (\u003ca href=\"#_ENREF_16\"\u003e16\u003c/a\u003e).\u003c/p\u003e\n\u003cp\u003eAlthough in our study, onset to needle time reduced by 32 min in the prehospital notification (SAMA) -transported patients in comparison to self-transported patients, it did not coincide with better neurological function. The authors presume that in order to make a statistically significant difference in neurological function between groups, more marked reduction in delay is needed to be made. Another assumption for diversity in results is that the real onset of stroke might be different from what is reported in patient documents. We thought that some patients might ignore mild signs for a while and call for a help when signs are getting worse. Therefore, some patients might lose the golden time for receiving thrombolysis before transport to hospital.\u0026nbsp;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere were some limitations to this study. Assessment of NIHSS and mRS by various assessors may result in measurement errors. Since just one hospital in Qom city is equipped to stroke center and number of admitted patients was partly small, sample size was another limitation. Larger sample size might increase the power of tests.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFinding of this study showed that performance of SAMA prehospital notification in reduction of treatment delay in acute ischemic strokes was acceptable to some extent. However, such amount of time reduction didn\u0026rsquo;t have significant effect on neurological deficit improvement. According to evidences, time is a determining factor in the effectiveness of thrombolytic therapy in acute ischemic strokes therefore stabilization of prehospital notification plans, such as SAMA code, in order to reduce delay time could likely be advantageous to decrease ischemic stroke complications. However, it is probable that more markedly reduction in delay time is needed for improvement of neurological dysfunctions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work approved by Iran national committee for ethics in biomedical research (record no. IR.MUQ.REC.1398.022) was supported by Qom University of medical science, Qom, Iran. The article was extracted from the MSc. student thesis of Azra Sangari. The consent to participate was waived due to retrospective study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026rsquo; statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo potential conflict of interest was reported by the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eNo funding to declare\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKA wrote the main manuscript text, AS gathered data and drafted the manuscript, and MV analyzed the data. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe\u0026nbsp;\u003cem\u003eauthors would like\u003c/em\u003e\u0026nbsp;to express their deepest gratitude to\u0026nbsp;Dr. Sharifipour and Dr. Momenian for their helpful advices and supports.\u0026nbsp; We would like to thank the staffs on Shahid beheshti hospital of Qom University of Medical Sciences for providing facilities for this work.\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003e\u003cstrong\u003e.1\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/strong\u003eDonkor ES. Stroke in the century: a snapshot of the burden, epidemiology, and quality of life. 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Journal of Stroke and Cerebrovascular Diseases. 2015;24(2):465-72. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.09.020\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e.18\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/strong\u003eMohamad NF, Hastrup S, Rasmussen M, Andersen MS, Johnsen SP, Andersen G, et al. Bypassing primary stroke centre reduces delay and improves outcomes for patients with large vessel occlusion. European Stroke Journal. 2016;1(2):85-92. https://doi.org/10.1177/2396987316647857\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e.19\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; \u003c/strong\u003eCandelaresi P, Lattuada P, Uggetti C, Dacc\u0026ograve; R, Fontana G, Frediani F. A high-urgency stroke code reduces in-hospital delays in acute ischemic stroke: a single-centre experience. Neurological Sciences. 2017;38(9):1671-6. https://doi.org/10.1007/s10072-017-3046-y\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e"},{"header":"Tables","content":"\u003cdiv align=\"center\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;text-align:right;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003ctable dir=\"rtl\" style=\"width:453.15pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 453.15pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 18.25pt;vertical-align: top;\"\u003e\n \u003cp dir=\"LTR\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color:black;\"\u003eTab. 1 Demographics characteristics and \u0026nbsp;comorbidities between \u0026nbsp;SAMA-transported and self-transported patients\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81.65pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21.8pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eP value\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21.8pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eself-transported\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eN=75\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21.8pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSAMA-transported\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eN=110\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 124pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 21.8pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom: 0in;margin-left:0in;text-align: right;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eVariable\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81.65pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 11.45pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.50\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 11.45pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e64\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 141.6pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 11.45pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e65\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121.9pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 11.45pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom: 0in;margin-left:0in;text-align: right;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eAge (Mean\u0026plusmn;SD)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81.65pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 14.6pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.79\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 14.6pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e56% men\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 141.6pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 14.6pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e53% men\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121.9pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 14.6pt;vertical-align: top;\"\u003e\n \u003cp dir=\"LTR\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:left;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color:black;\"\u003eGender %\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81.65pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 11.9pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e1*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 11.9pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e98% married\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 141.6pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 11.9pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e98% married\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121.9pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 11.9pt;vertical-align: top;\"\u003e\n \u003cp dir=\"LTR\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color:black;\"\u003eMarital status%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81.65pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.03\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e19\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 141.6pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121.9pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp dir=\"LTR\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color:black;\"\u003epast history of stroke %\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81.65pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.8pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.99\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.8pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 141.6pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.8pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121.9pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.8pt;vertical-align: top;\"\u003e\n \u003cp dir=\"LTR\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color:black;\"\u003epast history of TIA %\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81.65pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.39\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e21\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 141.6pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e27\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121.9pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp dir=\"LTR\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color:black;\"\u003ePast History of Heart Disease %\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81.65pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 11.9pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e1*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 11.9pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 141.6pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 11.9pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121.9pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 11.9pt;vertical-align: top;\"\u003e\n \u003cp dir=\"LTR\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color:black;\"\u003eSmoking %\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81.65pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e1*\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 141.6pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.009\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121.9pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp dir=\"LTR\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color:black;\"\u003eAddiction %\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81.65pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.38\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e52\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 141.6pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e45\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121.9pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp dir=\"LTR\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color:black;\"\u003eHypertensions %\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81.65pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.8pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.11\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.8pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e35\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 141.6pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.8pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e24\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121.9pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 12.8pt;vertical-align: top;\"\u003e\n \u003cp dir=\"LTR\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color:black;\"\u003eDiabetes %\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 81.65pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.78\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1.5in;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e12\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 141.6pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e11\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121.9pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 13.25pt;vertical-align: top;\"\u003e\n \u003cp dir=\"LTR\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color:black;\"\u003eDyslipidemia %\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"border:none;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cdiv align=\"center\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;text-align:right;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003ctable dir=\"rtl\" style=\"border: none;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 349.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 28.1pt;vertical-align: top;\"\u003e\n \u003cp dir=\"LTR\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color:black;\"\u003eTab. 2 Comparison of delay times between SAMA-transported and self-transported patients\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 46.55pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eP value\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119.85pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eMedian\u0026nbsp;\u003c/span\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e(IQR) min\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eGroup\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61.6pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eVariable\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width:46.55pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119.85pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt dashed windowtext;padding: 0in 5.4pt;height: 15.25pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e180 (150-225)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt dashed windowtext;padding: 0in 5.4pt;height: 15.25pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSelf \u0026ndash;transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:61.6pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:15.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eONT\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119.85pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e150 (120-180)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSAMA-transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width:46.55pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.22\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119.85pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt dashed windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e65 (40-115)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:121.5pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSelf \u0026ndash;transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:61.6pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eODT\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119.85pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e60 (40-88)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:121.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSAMA-transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width:46.55pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.0001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119.85pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt dashed windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e100 (80-125)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt dashed windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSelf \u0026ndash;transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:61.6pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eDNT\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119.85pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e80 (60-105)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSAMA-transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width:46.55pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 119.85pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt dashed windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e36 (24-52)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt dashed windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSelf \u0026ndash;transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:61.6pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eDCT\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119.85pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 10.55pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e27 (20-37)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 121.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 10.55pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSAMA-transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;text-align:justify;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;text-align:justify;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cdiv align=\"center\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;text-align:right;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003ctable dir=\"rtl\" style=\"border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 394.05pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eTab. 3 Comparison of neurological deficit improvement between SAMA-transported and self-transported patients\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 45.55pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eP value\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eMedian (\u003c/span\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e(IQR)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.2pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eGroup\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.8pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eVariable\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width:45.55pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.9pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.17\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt dashed windowtext;padding: 0in 5.4pt;height: 11.9pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e13 (10-16)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.2pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt dashed windowtext;padding: 0in 5.4pt;height: 11.9pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSelf \u0026ndash;transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:106.8pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.9pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eAdmission NIHSS\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e15 (10-18)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.2pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSAMA-transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width:45.55pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.97\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt dashed windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e1 (0-4.25)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.2pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt dashed windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSelf \u0026ndash;transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:106.8pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eDischarge NIHSS\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e1 (0-5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.2pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSAMA-transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width:45.55pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.07\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt dashed windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e4 (3-5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.2pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt dashed windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSelf \u0026ndash;transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:106.8pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eAdmission mRS\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e5 (4-5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.2pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSAMA-transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width:45.55pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:12.0pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.30\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt dashed windowtext;padding: 0in 5.4pt;height: 12pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e1 (0-1)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.2pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt dashed windowtext;padding: 0in 5.4pt;height: 12pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSelf \u0026ndash;transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:106.8pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:12.0pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eDischarge mRS\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114.5pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 10.55pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;text-align:center;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e1 (0-3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 127.2pt;border-top: none;border-right: none;border-left: none;border-image: initial;border-bottom: 1pt solid windowtext;padding: 0in 5.4pt;height: 10.55pt;vertical-align: top;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSAMA-transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;text-align:justify;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp dir=\"RTL\" style='margin-top:12.0pt;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;text-align:justify;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cdiv align=\"center\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;text-align:right;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003ctable dir=\"rtl\" style=\"border: none;width:461.2pt;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width:461.2pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:23.65pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eTab. 4 Comparison of neurological deficit improvement in SAMA-transported and self-transported patients\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:50.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.75pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eP value\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:122.7pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.75pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eMedian\u0026nbsp;\u003c/span\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e(IQR) min\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:135.0pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.75pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eGroup\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:153.0pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:11.75pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eVariable\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width:50.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:19.1pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;text-align:center;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.22\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:122.7pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:19.1pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;text-align:center;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e10 (8-13)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:135.0pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:19.1pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSelf \u0026ndash;transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:153.0pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:19.1pt;\"\u003e\n \u003cp dir=\"LTR\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color:black;\"\u003eneurological deficit improvement on\u0026nbsp;\u003c/span\u003e\u003cspan style=\"color:black;\"\u003eNIHSS\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:122.7pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.45pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;text-align:center;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e11 (7-15)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:135.0pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.45pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSAMA-transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width:50.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:23.5pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;text-align:center;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.89\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:122.7pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:23.5pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;text-align:center;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e3 (2-4)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:135.0pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:23.5pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSelf \u0026ndash;transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:153.0pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:23.5pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eneurological deficit improvement on\u0026nbsp;\u003c/span\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003emRS\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:122.7pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:17.75pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;text-align:center;line-height: normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e3 (2-4)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:135.0pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:17.75pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSAMA-transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;text-align:justify;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;text-align:justify;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color:black;\"\u003eTab. 5 Correlation\u003c/span\u003e\u003cspan style=\"color:black;\"\u003e\u0026nbsp;between neurological\u003c/span\u003e\u003cspan style=\"color:black;\"\u003e\u0026nbsp;deficit severity\u003c/span\u003e\u003cspan style=\"color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003cspan style=\"color:black;\"\u003emeasured by\u0026nbsp;\u003c/span\u003e\u003cspan style=\"color:black;\"\u003eNIHSS\u003c/span\u003e\u003cspan style=\"color:black;\"\u003e\u0026nbsp;and delay times\u003c/span\u003e\u003c/p\u003e\n\u003cdiv align=\"center\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;text-align:right;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003ctable dir=\"rtl\" style=\"border: none;width:461.4pt;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:57.25pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:17.95pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eP value\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:120.5pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:17.95pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003ecorrelation coefficient r\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:186.9pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:17.95pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eGroup\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:96.75pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:none;padding:0in 5.4pt 0in 5.4pt;height:17.95pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eVariable\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:57.25pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:23.5pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.53\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:120.5pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:23.5pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.08\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:186.9pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:23.5pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSelf \u0026ndash;transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width:96.75pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:23.5pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eONT\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:57.25pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.80\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:120.5pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e-0.03\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:186.9pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSAMA-transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:57.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.74\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:120.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.025\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:186.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eAll patients\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:57.25pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.05\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:120.5pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.24\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:186.9pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSelf \u0026ndash;transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width:96.75pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eODT\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:57.25pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.72\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:120.5pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e-0.04\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:186.9pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSAMA-transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:57.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.30\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:120.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.08\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:186.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eAll patients\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:57.25pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.35\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:120.5pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.11\u003c/span\u003e\u003cspan style=\"color:black;\"\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:186.9pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSelf \u0026ndash;transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width:96.75pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eDNT\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:57.25pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.50\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:120.5pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.07\u003c/span\u003e\u003cspan style=\"color:black;\"\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:186.9pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSAMA-transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:57.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.11\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:120.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.013\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:186.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eAll patients\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:57.25pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.14\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:120.5pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.19\u003c/span\u003e\u003cspan style=\"color:black;\"\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:186.9pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSelf \u0026ndash;transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width:96.75pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eDCT\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:57.25pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.14\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:120.5pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.15\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:186.9pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSAMA-transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:57.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.90\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:120.5pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.010\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:186.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eAll patients\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;text-align:justify;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;text-align:justify;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cdiv align=\"center\" style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;text-align:right;line-height:107%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\n \u003ctable dir=\"rtl\" style=\"width:461.4pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width:461.4pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:13.25pt;\"\u003e\n \u003cp dir=\"LTR\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align:justify;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan style=\"color:black;\"\u003eTab. 6 Correlation\u003c/span\u003e\u003cspan style=\"color:black;\"\u003e\u0026nbsp;between neurological\u003c/span\u003e\u003cspan style=\"color:black;\"\u003e\u0026nbsp;deficit improvement\u003c/span\u003e\u003cspan style=\"color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003cspan style=\"color:black;\"\u003emeasured by\u0026nbsp;\u003c/span\u003e\u003cspan style=\"color:black;\"\u003emRS\u003c/span\u003e\u003cspan style=\"color:black;\"\u003e\u0026nbsp;and delay times\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:57.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:17.95pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eP value\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:155.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:17.95pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003ecorrelation coefficient r\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:161.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:17.95pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eGroup\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:87.0pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:17.95pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eVariable\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:57.25pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:23.5pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.63\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:155.9pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:23.5pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.06\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:161.25pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:23.5pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSelf \u0026ndash;transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width:87.0pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:23.5pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eONT\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:57.25pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.89\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:155.9pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.14\u003c/span\u003e\u003cspan style=\"color:black;\"\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:161.25pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSAMA-transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:57.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.95\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:155.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.05\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:161.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eAll patients\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:57.25pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.26\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:155.9pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.14\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:161.25pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSelf \u0026ndash;transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width:87.0pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eODT\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:57.25pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.86\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:155.9pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.02\u003c/span\u003e\u003cspan style=\"color:black;\"\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:161.25pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSAMA-transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:57.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.56\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:155.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.04\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:161.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eAll patients\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:57.25pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.41\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:155.9pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e-0.10\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:161.25pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSelf \u0026ndash;transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width:87.0pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eDNT\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:57.25pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.68\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:155.9pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.04\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:161.25pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSAMA-transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:57.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.90\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:155.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.01\u003c/span\u003e\u003cspan style=\"color:black;\"\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:161.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eAll patients\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:57.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.32\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:155.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.13\u003c/span\u003e\u003cspan style=\"color:black;\"\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:161.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSelf \u0026ndash;transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width:87.0pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eDCT\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:57.25pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.30\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:155.9pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.10\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:161.25pt;border:none;border-bottom:dashed windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eSAMA-transported\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:57.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.89\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:155.9pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e0.01\u003c/span\u003e\u003cspan style=\"color:black;\"\u003e-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:161.25pt;border:none;border-bottom:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:20.25pt;\"\u003e\n \u003cp dir=\"RTL\" style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;text-align: center;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003eAll patients\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp dir=\"RTL\" style='margin-top:12.0pt;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;text-align:justify;line-height:150%;font-size:15px;font-family:\"Calibri\",sans-serif;'\u003e\u003cspan dir=\"LTR\" style=\"color:black;\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"delay time, thrombolysis therapy, neurological outcome, prehospital notification, ischemic stroke","lastPublishedDoi":"10.21203/rs.3.rs-440192/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-440192/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eSince timely thrombolytic therapy is a crucial variable in acute ischemic stroke recovery, health care systems are trying to find new interventions to reduce treatment delay in order to improve neurological function.\u0026nbsp;In Iran, SAMA code as a prehospital notification plan has been developed to help emergent stroke treatment. This study aimed to compare time delay to thrombolysis therapy and neurological outcomes between prehospital notification (SAMA)-transported patients and self-transported patients in acute ischemic stroke.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods and materials: \u003c/strong\u003eIn this retrospective cohort study, the data of 185 stroke patients treated with intravenous thrombolysis were gathered. There were two groups including, SAMA-transported (n=110) patients and self-transported (n=75) patients. The treatment delays including, onset to needle time (ONT), onset to door time, (ODT), door to CT time (DCT) and door to needle time (DNT) as well the neurological scores measured using NIHSS and mRS were analyzed between two groups. p-value\u0026lt;0.05 was considered as significant.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe results showed that delay times reduced in SAMA-transported patient compared to that in self-transported patients. The findings revealed a significant difference in ONT (150 (120-180) vs 180 (150-225) (p=0.001), DNT (80 (60-105) vs 100 (80-125) (p=0.0001), and DCT (27 (20-37) vs 36 (24-52) (p=0.001) between SAMA-transported patients and self-transported patients. The times are represented as minute (median and IQR). \u0026nbsp;However, there was no significant difference \u003cem\u003ebetween two groups \u003c/em\u003ein terms of neurologic deficit severity\u003cem\u003e. Also, there was no relationship between the delay time and \u003c/em\u003eneurological outcomes. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eAlthough SAMA prehospital notification could partially reduce treatment delay times in acute ischemic stroke, such reduction was not enough to impact on neurologic deficit recovery. It seems more reduction in delay time is needed to significant improvement of neurological dysfunctions.\u003c/p\u003e","manuscriptTitle":"Prehospital notification reduced time delays but not neurological outcomes in acute ischemic stroke","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-04-28 14:05:45","doi":"10.21203/rs.3.rs-440192/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4b5100ae-ae88-4a2e-b020-f0e51ed693cc","owner":[],"postedDate":"April 28th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":3954590,"name":"Neurology"}],"tags":[],"updatedAt":"2021-05-20T04:14:04+00:00","versionOfRecord":[],"versionCreatedAt":"2021-04-28 14:05:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-440192","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-440192","identity":"rs-440192","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}