title: Off-hours admission for acute stroke is not associated with worse outcome--a nationwide Israeli stroke project.
abstract: OBJECTIVE
  Several studies reported worse outcome for stroke patients arriving on weekends. We compared working hours to off-work hours throughout the week as there is lack of experienced staff and special services during off-hours.
  
  
  METHODS
  A nationwide stroke survey project on acute stroke was carried out in all acute care hospitals in Israel during 2004, 2007 and 2010 (2-month each). 'On-hours' were defined as regular Israel working hours and the rest, including holidays, were defined as 'off-hours'. The modified Rankin scale (mRS) at discharge was used for the main analysis on outcome.
  
  
  RESULTS
  A total of 4827 acute strokes patients were analyzed (2139 arrived on-hours and 2688 during off-hours). 'Off-hours' patients were 1 year younger (mean 70 vs. 71 years in 'on-hours') had lower rates of prior cardiac interventions, but had higher admission blood pressure levels and had more intracerebral hemorrhages (ICH) (11% vs. 8% in 'on-hours' patients, P < 0.001). Death during hospitalization was recorded in 9% of 'off-hours' vs. 6% of 'on-hours' patient (P = 0.004). Controlling for age, blood pressure, stroke type, pre-stroke mRS, admission NIHSS, and thrombolysis, the relative odds of poor outcome (i.e. mRS ≥ 2) amongst 'off-hours' admissions compared to on-hours was 1.09 (95% CI: 0.92-1.30). Odds ratio amongst ischaemic stroke patients was 1.08 (95% CI: 0.88-1.33).
  
  
  CONCLUSIONS
  Off-hours stroke admissions were associated with higher short-term mortality rate, probably due to a higher rate of ICH. After controlling for the latter and other potential confounders, 'off-hours' admissions were not different from 'on-hours' with respect to poor outcome.
authors.affiliation: Neurology Unit, Rabin Medical Center, Golda Campus, Petach Tikva, Israel.
authors.forename: J Y
authors.initials: JY
authors.lastname: Streifler
authors.forename: M
authors.initials: M
authors.lastname: Benderly
authors.forename: N
authors.initials: N
authors.lastname: Molshatzki
authors.forename: N
authors.initials: N
authors.lastname: Bornstein
authors.forename: D
authors.initials: D
authors.lastname: Tanne
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage; D005260:Female; D006306:Health Surveys; D006693:Holidays; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data*; D020521:Stroke / Q000145:classification / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*