Evaluation of Off-Hour Emergency Care in Acute Ischemic Stroke: Results from the China National Stroke Registry

Abstract

Background and PurposeThe quality of after-hour emergency care of patients with acute ischemic stroke is debatable. We therefore, sought to analyze the performance measures, quality of care and clinical outcomes in these patients admitted during off-hours.MethodsOur study included 4493 patients from a selected cohort of patients admitted to the hospitals with ischemic stroke in the China National Stroke Registry (CNSR) from September 2007 to August 2008. On-hour presentation was defined as arrival at the emergency department from the scene between 8AM and 5PM from Monday through Friday. Off-hours included the remainder of the on-hours and statutory holidays. The association between off-hour presentation and outcome was analyzed using multivariate logistic-regression models.ResultsOff-hour presentation was identified in 2672 (59.5%) patients with ischemic stroke. Comparison of patients admitted during off-hours with those admitted during on-hours revealed an unadjusted odds ratio of in-hospital mortality of 1.38 (95% confidence interval, 1.04–1.85), which declined to 1.34 (95% confidence interval, 0.93–1.93) after adjusting for patient characteristics (especially, pre-hospital delay). No difference in 30-day mortality, total death or dependence at three, six and 12 months between two groups was observed. No association between off-hour admission and quality of care was found.ConclusionsIn the CNSR database, compared with on-hour patients, off-hour patients with acute ischemic stroke admitted to the emergency departments from scene manifested a higher incidence of in-hospital mortality. However, the difference in incidence and quality of care between the groups disappeared after adjusting for pre-hospital delay and other variables.

Mortality of Major Cardiovascular Emergencies among Patients Admitted to Hospitals on Weekends as Compared with Weekdays in Taiwan

“…[21][22][23][24][25] On the contrary, several studies found that off-hour admission was not associated with an unfavorable outcome in acute ischemic stroke patients. [26][27][28][29][30][31][32] As for pulmonary embolism, hospitalization on weekends seemed to be associated with a signi cantly higher mortality rate than hospitalization on weekdays in two publications. 3,33 Taiwan has commenced a universal NHI program, nanced jointly by payroll taxes, subsidies, and individual premiums, since 1995.…”

Impact of Off-Hour Hospital Presentation on Mortality in Different Subtypes of Acute Stroke in Korea : National Emergency Department Information System Data

“…Several observational studies have assessed the ‘off-hour effect’ in patients with IS. Prior studies have reported incoherent results on whether off-hour admission is associated with worse outcome after IS [ 5 , 22 , 24 , 28 ] or not [ 4 , 10 , 13 , 15 , 19 , 27 , 29 ]. In a retrospective study of 26676 IS subjects from the Hospital Morbidity Database of 606 hospitals in Canada, Saposnik et al [ 25 ] reported that weekend admission was associated with early mortality, which was similarly observed among subjects presented to urban versus rural medical centers or specialist versus a general practitioner.…”

Stroke care quality in China: Substantial improvement, and a huge challenge and opportunity

“…However, the difference in incidence and quality of care between the two groups disappeared after adjusting for pre-hospital delay and other variables. 12…”