Open AccessOff-Hour Effect on 3-Month Functional Outcome after Acute Ischemic Stroke: A Prospective Multicenter Registry
Author(s) -
ChulHo Kim,
Min Uk Jang,
Mi Sun Oh,
Jong-Ho Park,
San Jung,
Ju-Hun Lee,
KyungHo Yu,
Moon Ku Han,
Beom Joon Kim,
Tai Hwan Park,
SangSoon Park,
Kyung Bok Lee,
Jae Kwan,
Dae-Hyun Kim,
Jun Lee,
Sunghun Kim,
Soo Joo Lee,
Young Hwii Ko,
JongMoo Park,
Kyusik Kang,
Youngjin Cho,
KeunSik Hong,
Ki-Hyun Cho,
JoonTae Kim,
DongEog Kim,
Jay Chol Choi,
Myung Suk Jang,
HeeJoon Bae,
ByungChul Lee
Publication year - 2014
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0105799
Subject(s) - medicine , modified rankin scale , thrombolysis , stroke (engine) , prospective cohort study , logistic regression , emergency medicine , odds ratio , emergency department , ischemic stroke , ischemia , myocardial infarction , mechanical engineering , psychiatry , engineering
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.