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  • Title: Off-hour effect on 3-month functional outcome after acute ischemic stroke: a prospective multicenter registry.
    Author: Kim C, Jang MU, Oh MS, Park JH, Jung S, Lee JH, Yu KH, Han MK, Kim BJ, Park TH, Park SS, Lee KB, Cha JK, Kim DH, Lee J, Kim SH, Lee SJ, Ko Y, Park JM, Kang K, Cho YJ, Hong KS, Cho KH, Kim JT, Kim DE, Choi JC, Jang MS, Bae HJ, Lee BC, CRCS-5 investigatorsDepartment of Neurology, Hallym University Sacred Heart Hospital, Chuncheon-si, Republic of Korea..
    Journal: PLoS One; 2014; 9(8):e105799. PubMed ID: 25165816.
    Abstract:
    BACKGROUND AND PURPOSE: The time of hospital arrival may have an effect on prognosis of various vascular diseases. We examined whether off-hour admission would affect the 3-month functional outcome in acute ischemic stroke patients admitted to tertiary hospitals. METHODS: We analyzed the 'off-hour effect' in consecutive patients with acute ischemic stroke using multi-center prospective stroke registry. Work-hour admission was defined as when the patient arrived at the emergency department between 8 AM and 6 PM from Monday to Friday and between 8 AM and 1 PM on Saturday. Off-hour admission was defined as the rest of the work-hours and statutory holidays. Multivariable logistic regression was used to analyze the association between off-hour admission and 3-month unfavorable functional outcome defined as modified Rankin Scale (mRS) 3-6. Multivariable model included age, sex, risk factors, prehospital delay time, intravenous thrombolysis, stroke subtypes and severity as covariates. RESULTS: A total of 7075 patients with acute ischemic stroke were included in this analysis: mean age, 67.5 (±13.0) years; male, 58.6%. In multivariable analysis, off-hour admission was not associated with unfavorable functional outcome (OR, 0.89; 95% CI, 0.72-1.09) and mortality (OR, 1.09; 95% CI, 0.77-1.54) at 3 months. Moreover, off-hour admission did not affect a statistically significant shift of 3-month mRS distributions (OR, 0.90; 95% CI, 0.78-1.05). CONCLUSIONS: 'Off-hour' admission is not associated with an unfavorable 3-month functional outcome in acute ischemic stroke patients admitted to tertiary hospitals in Korea. This finding indicates that the off-hour effects could be overcome with well-organized stroke management strategies.
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