A multifaceted look at time of admission and its impact on case-fatality among a cohort of ischemic stroke patients

Uzor C Ogbu (1) , Gert P Westert (2) , Laurentius Cj Slobbe (3) , Karien Stronks (4) , Onyebuchi A Arah (5)

1 AMC - Academic Medical Center - Academisch Medisch Centrum [Amsterdam]
2 Center for Transformation of Care and Welfare, Tilburg University
3 RIVM - National Institute for Public Health and the Environment [Bilthoven]
4 Department of Social Medicine, University of Amsterdam
5 UCLA - University of California [Los Angeles]

Purpose: Off-hours admissions have been associated with an increased risk of poor outcomes but results have been inconsistent, possibly due to different measures of off-hours care used. We examined, using a single condition and increasingly refined definitions of time of admission, the effect of off-hours admissions on seven-day stroke case-fatality Methods: We studied a retrospective cohort of 82,219 ischemic stroke admissions to 115 Dutch hospitals between 2000 and 2004. Data were from the Dutch Medical Register and analyzed using multivariable multilevel logistic regression. We adjusted for variables such as age, gender, Charlson-Deyo comorbidity score, urgency of admission, hospital teaching status and specialty of attending physician. Results: After adjustment, we observed higher seven-day fatality risk for weekend admissions when compared to weekday admissions (odds ratio [OR] 1.27; 95% Confidence interval [CI], 1.20 – 1.34). Sunday displayed the highest risk of fatality (OR 1.31; 95% CI 1.20 – 1.44). With the Monday day-shift as a reference, the fatality odds were increased during the Sunday and Saturday day-shifts, the evening-shifts on Sunday and Monday, and during all night-shifts. The night-shift OR's ranged from 1.94 (95% CI 1.56 – 2.41), to 2.14 (95% CI 1.74 – 2.63). When compared to admission at 8:00 AM we observed increased fatality odds from midnight until 7:00 AM and decreased fatality odds from 2:00 PM until 6:00 PM. Conclusions: Weekends represent a period of increased fatality risk for ischemic stroke patients in the Netherlands. However, this increased risk appears to represent an exacerbation of an underlying nighttime risk present during the weekdays.

Mots clés: CEREBROVASCULAR DISEASE; STROKE

Uzor C Ogbu, Gert P Westert, Laurentius Cj Slobbe, Karien Stronks, Onyebuchi A Arah. A multifaceted look at time of admission and its impact on case-fatality among a cohort of ischemic stroke patients. Journal of Neurology, Neurosurgery and Psychiatry, 2010, 82 (1), pp.8. ⟨10.1136/jnnp.2009.202176⟩. ⟨hal-00560317⟩