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Off-hours admission for acute stroke is not associated with worse outcome - a nationwide Israeli stroke project.
MedLine Citation:
PMID:  22136626     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background and purpose:  Several studies reported worse outcome for stroke patients arriving on weekends. We compared working hours to off-work hours throughout the week as there is lack of experienced staff and special services during off-hours. Methods:  A nationwide stroke survey project on acute stroke was carried out in all acute care hospitals in Israel during 2004, 2007 and 2010 (2-month each). 'On-hours' were defined as regular Israel working hours and the rest, including holidays, were defined as 'off-hours'. The modified Rankin scale (mRS) at discharge was used for the main analysis on outcome. Results:  A total of 4827 acute strokes patients were analyzed (2139 arrived on-hours and 2688 during off-hours). 'Off-hours' patients were 1 year younger (mean 70 vs. 71 years in 'on-hours') had lower rates of prior cardiac interventions, but had higher admission blood pressure levels and had more intracerebral hemorrhages (ICH) (11% vs. 8% in 'on-hours' patients, P < 0.001). Death during hospitalization was recorded in 9% of 'off-hours' vs. 6% of 'on-hours' patient (P = 0.004). Controlling for age, blood pressure, stroke type, pre-stroke mRS, admission NIHSS, and thrombolysis, the relative odds of poor outcome (i.e. mRS ≥ 2) amongst 'off-hours' admissions compared to on-hours was 1.09 (95% CI: 0.92-1.30). Odds ratio amongst ischaemic stroke patients was 1.08 (95% CI: 0.88-1.33). Conclusions:  Off-hours stroke admissions were associated with higher short-term mortality rate, probably due to a higher rate of ICH. After controlling for the latter and other potential confounders, 'off-hours' admissions were not different from 'on-hours' with respect to poor outcome.
Authors:
J Y Streifler; M Benderly; N Molshatzki; N Bornstein; D Tanne
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-12-5
Journal Detail:
Title:  European journal of neurology : the official journal of the European Federation of Neurological Societies     Volume:  -     ISSN:  1468-1331     ISO Abbreviation:  -     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-12-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9506311     Medline TA:  Eur J Neurol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 The Author(s). European Journal of Neurology © 2011 EFNS.
Affiliation:
Neurology Unit, Rabin Medical Center, Golda Campus, Petach Tikva Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv The Israel Society for the Prevention of Heart Attacks (ISPHA), Neufeld Cardiac Research Institute, Sheba Medical Center, Tel-Hashomer Department Neurology and Sagol Neuroscience Center, Sheba Medical Center, Tel-Hashomer Neurology Department, Tel Aviv Medical Center, Tel Aviv, Israel.
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