title: Impact of hospital admission during nonworking hours on patient outcomes after thrombolysis for stroke.
abstract: OBJECTIVE
  Whether the time of hospital admission is relevant for short-term outcome after stroke is under debate and may depend on care facilities.
  
  
  METHODS
  We retrospectively analyzed medical records from patients who received thrombolytic therapy within 4.5 hours of stroke onset in a stroke unit of the Charité-University Hospital Berlin (Charité; n=291) or within the stroke telemedicine (TEMPiS) network, comprising 12 community hospitals with telestroke units in Bavaria (n=616).
  
  
  RESULTS
  Thrombolytic therapy was administered during nonworking hours in 59.5% (Charité) and 55.0% (TEMPiS) of patients. A trend toward a lower rate of symptomatic intracranial hemorrhage (3.4% versus 9.2%; P=0.053), clinical worsening (11.9% versus 19.7%; P=0.079), and 7-day mortality (3.4% versus 8.7%; P=0.073) after admission during working hours was seen at Charité. However, multivariable analysis did not show a significant impact of the time of admission on clinical worsening, symptomatic intracranial hemorrhage, or 7-day mortality in both cohorts. Thrombolysis based on brain computed tomography instead of magnetic resonance imaging (odds ratio=4.98, 95% CI, 1.09 to 22.7) and more severe National Institutes of Health Stroke Scale score on admission (odds ratio=1.15 per point; 95% CI, 1.07 to 1.24) were associated with 7-day mortality at Charité. National Institutes of Health Stroke Scale score on admission (odds ratio=1.13 per point; 95% CI, 1.06 to 1.19) and older age (odds ratio=1.05 per year; 95% CI, 1.004 to 1.09) were correlated with 7-day mortality in TEMPiS. National Institutes of Health Stroke Scale on admission was the only independent predictor of symptomatic intracranial hemorrhage or clinical worsening in both cohorts.
  
  
  CONCLUSIONS
  The majority of stroke patients received thrombolysis during nonworking hours. The time of hospital admission did not significantly influence the short-term outcome after thrombolysis.
authors.affiliation: Center for Stroke Research and Department of Neurology, Charité-University Medicine Berlin , Campus Benjamin Franklin, Hindenburgdamm 30, D-12200 Berlin, Germany. georg.haeusler@charite.de
authors.forename: Karl Georg
authors.initials: KG
authors.lastname: Haeusler
authors.forename: Lea M
authors.initials: LM
authors.lastname: Gerischer
authors.forename: Bijan
authors.initials: B
authors.lastname: Vatankhah
authors.forename: Heinrich J
authors.initials: HJ
authors.lastname: Audebert
authors.forename: Christian H
authors.initials: CH
authors.lastname: Nolte
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011859:Radiography; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors