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01-03-2019 | Neurological Update

Comparison of outcome in stroke patients admitted during working hours vs. off-hours; a single-center cohort study

Authors: M. P. Tuinman, E. G. A. van Golde, R. P. Portier, I. L. H. Knottnerus, J. van der Palen, H. M. den Hertog, P. J. A. M. Brouwers

Published in: Journal of Neurology | Issue 3/2019

Abstract

Introduction

We aimed to disprove an in-hospital off-hour effect in stroke patients by adjusting for disease severity and poor prognostic findings on imaging.

Patients and methods

Our study included 5378 patients from a single center prospective stroke registry of a large teaching hospital in the Netherlands, admitted between January 2003 and June 2015. Patients were categorized by admission time, off-hours (OH) or working hours (WH). The in-hospital mortality, 7-day mortality, unfavorable functional outcome (modified Rankin scale > 2) and discharge to home were analyzed. Results were adjusted for age, sex, stroke severity (NIHSS score) and unfavorable findings on imaging of the brain (midline shift and dense vessel sign).

Results

Overall, 2796 patients (52%) were admitted during OH, which had a higher NIHSS score [3 (IQR 2–8) vs. 3 (IQR 2–6): p < 0.01] and had more often a dense vessel sign at admission (7.9% vs. 5.4%: p < 0.01). There was no difference in mortality between the OH-group and WH-group (6.2% vs. 6.0%; p = 0.87). The adjusted hazard ratio of in-hospital mortality during OH was 0.87 (95% CI: 0.70–1.08). Analysis of 7-day mortality showed similar results. Unadjusted, the OH-group had an unfavorable outcome [OR: 1.14 (95% CI: 1.02–1.27)] and could less frequently be discharged to home [OR: 1.16 (95% CI: 1.04–1.29)], which was no longer present after adjustment.

Discussion and conclusions

The overall outcome of stroke patients admitted to a large Dutch teaching hospital is not influenced by time of admission. When studying OH effects, adjustment for disease severity and poor prognostic findings on imaging is crucial before drawing conclusions on staffing and material.

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Title: Comparison of outcome in stroke patients admitted during working hours vs. off-hours; a single-center cohort study
Authors: M. P. Tuinman
E. G. A. van Golde
R. P. Portier
I. L. H. Knottnerus
J. van der Palen
H. M. den Hertog
P. J. A. M. Brouwers
Publication date: 01-03-2019
Publisher: Springer Berlin Heidelberg
Published in: Journal of Neurology / Issue 3/2019
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-018-9079-1

At a glance: The STEP trials

Springer Medicine

Comparison of outcome in stroke patients admitted during working hours vs. off-hours; a single-center cohort study

Abstract

Introduction

Patients and methods

Results

Discussion and conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Patients and methods

Results

Discussion and conclusions

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