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

Tuinman, Maarten P.; Golde, E. G. A. van; Portier, R; Knottnerus, Iris L.H.; Palen, Job van der; Hertog, Heleen M. den; Brouwers, P. J. A. M.

doi:10.1007/s00415-018-9079-1

J Neurol

2018

DOI: 10.1007/s00415-018-9079-1

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

Maarten P. Tuinman

E. G. A. van Golde

R Portier

et al.

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Cited by 3 publications

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“…Previous studies have evaluated the impact on door to needle, door to groin puncture, short‐term hospital mortality, and long‐term clinical outcomes in patients presenting to the hospital during working and nonworking hours. A negative “off‐hours effect” in many of these studies has been attributed to less experienced physicians at night, fewer available staff, and lack of advanced imaging availability 4,5 . However, this effect was not detected in patients presenting to CSCs, likely attributable to higher quality of care and efficient stroke protocols 5 .…”

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confidence: 99%

“…4,5 However, this effect was not detected in patients presenting to CSCs, likely attributable to higher quality of care and efficient stroke protocols. 5 As treatment of LVOs advances, attempts to improve efficiency and reduce costs have been made across the stroke systems of care. Currently, prehospital stroke triage depends largely on mobile stroke units, which often operate only during the day, and prehospital stroke severity scales administered by emergency medical services personnel.…”

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confidence: 99%

“…A negative "off-hours effect" in many of these studies has been attributed to less experienced physicians at night, fewer available staff, and lack of advanced imaging availability. 4,5 However, this effect was not detected in patients presenting to CSCs, likely attributable to higher quality of care and efficient stroke protocols. 5 As treatment of LVOs advances, attempts to improve efficiency and reduce costs have been made across the stroke systems of care.…”

mentioning

confidence: 99%

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Performance of the RACE Prehospital Triage Score During Working and Nonworking Hours

Salahuddin

Castonguay

Hitomi

et al. 2021

SVIN

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Background Prehospital triage scores aim to identify large vessel occlusions (LVOs) in the field; however, their real‐world performance and accuracy across a 24‐hour period remains unknown. In this study, we compare the positive predictive value of the prehospital Rapid Arterial occlusion Evaluation (RACE) score for the detection of LVO during working hours and nonworking hours. Methods We performed a retrospective review of all patients presenting with a RACE score of ≥5 at one comprehensive and one thrombectomy‐capable hospital between July 2015 and December 2019. Patients were dichotomized to those presenting during “working hours” (7:00 am to 6:00 pm on weekdays) or “nonworking hours” (6:01 pm to 6:59 am on weekdays or anytime during weekends). The primary outcome was diagnosis of LVO. Secondary outcomes included diagnosis of acute neurovascular syndromes, door‐to‐treatment time metrics, and a modified Rankin Scale of ≤2 in those undergoing mechanical thrombectomy. Results Of the 701 patients with RACE score ≥5, 687 patients were included (355 nonworking hours and 332 working‐hours cohorts). Mean age was 71 and 72 years in the nonworking hours and working hours groups, respectively ( P =0.13). Median National Institutes of Health Stroke Scale and baseline demographics were comparable between the 2 groups. There was no significant difference in the diagnosis of LVO (36.3% versus 34.6%; P =0.69) or final discharge diagnosis. The positive predictive value of the RACE score for the detection of an acute neurovascular syndrome (transient ischemic attack and stroke) was improved during nonworking hours (76.3% versus 67.8%; P =0.01). In patients undergoing mechanical thrombectomy, rates of good clinical outcome were similar (44.7% versus 48%; P =0.76), despite the shorter door‐to‐groin‐puncture and revascularization times during working hours. Conclusions The RACE score shows a consistent positive predictive value in determining LVO during working and nonworking hours. However, it is more accurate in determining acute neurovascular syndromes during nonworking hours, which is driven by a decrease in stroke mimics during this time.

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confidence: 99%

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Performance of the RACE Prehospital Triage Score During Working and Nonworking Hours

Salahuddin

Castonguay

Hitomi

et al. 2021

SVIN

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Nighttime and non-business days are not associated with increased risk of in-hospital mortality in patients with severe sepsis in intensive care units in Japan: The JAAM FORECAST study

Matsumura

Nakada

Abe

et al. 2019

Journal of Critical Care

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Mechanical Thrombectomy in Nighttime Hours: Is There a Difference in 90-Day Clinical Outcome for Patients with Ischemic Stroke?

Benali¹,

Moynier²,

Dargazanli³

et al. 2021

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Few data are available regarding the influence of the timing of ischemic stroke management, such as daytime and nighttime hours, on the delay of mechanical thrombectomy, the effectiveness of revascularization, and clinical outcomes. We aimed to investigate whether admission during nighttime hours could impact the clinical outcome (mRS at 90 days) of patients with acute ischemic stroke treated by mechanical thrombectomy. MATERIALS AND METHODS:We retrospectively analyzed 169 patients (112 treated during daytime hours and 57 treated during nighttime hours) with acute ischemic stroke in the anterior cerebral circulation. The main outcome was the rate of patients achieving functional independence at 90 days (mRS #2), depending on admission time. RESULTS:In patients admitted during nighttime hours, the rate of mRS # 2 at 90 days was significantly higher (51% versus 35%, P ¼ .05) compared with those admitted in daytime hours. Patients in daytime and nighttime hours were comparable regarding admission and treatment characteristics. However, patients in nighttime hours tended to have a higher median NIHSS score at admission (P ¼ .08) and to be younger (P ¼ .08), especially among the mothership group (P ¼ .09). The multivariate logistic regression analysis confirmed that patients in nighttime hours had better functional outcomes at 90 days than those in daytime hours (P ¼ .018; 95% CI, 0.064-0.770; OR ¼ 0.221). CONCLUSIONS:In a highly organized stroke care network, mechanical thrombectomy is quite effective in the nighttime hours among acute ischemic stroke presentations. Unexpectedly, we found that those patients achieved favorable clinical outcomes more frequently than those treated during daytime hours. Larger series are needed to confirm these results.ABBREVIATIONS: AIS ¼ acute ischemic stroke; CSC ¼ comprehensive stroke center; END ¼ early neurologic deterioration; ENI ¼ early neurologic improvement; IQR ¼ interquartile range; MT ¼ mechanical thrombectomy; mTICI ¼ modified TICI; sICH ¼ symptomatic intracranial hemorrhage B lood flow restoration is the principal therapeutic goal in acute ischemic stroke (AIS). IV rtPA is recommended for all eligible patients within 4.5 hours of of symptoms onset. For patients with AIS with acute large-vessel occlusion, mechanical thrombectomy (MT) is highly beneficial and recommended as a standard of care. 1 Functional outcomes are better when the MT is performed early after stroke onset. 2 The impact of admission hours on short-term prognosis of patients with AIS is still controversial. Some series investigated whether patients with AIS admitted during off-hours (Monday to Friday between 6 PM and 8 AM and weekends) had different outcomes compared with patients admitted during on-hours. One study reported that patients in off-hours had higher short-term mortality, greater disability at discharge, and worse outcomes at 90 days than patients admitted during working hours. 3 Conversely, another study suggested that rates of poor 90-day outcomes (mRS .2) were simila...

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

Cited by 3 publications

References 49 publications

Performance of the RACE Prehospital Triage Score During Working and Nonworking Hours

Performance of the RACE Prehospital Triage Score During Working and Nonworking Hours

Nighttime and non-business days are not associated with increased risk of in-hospital mortality in patients with severe sepsis in intensive care units in Japan: The JAAM FORECAST study

Mechanical Thrombectomy in Nighttime Hours: Is There a Difference in 90-Day Clinical Outcome for Patients with Ischemic Stroke?

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