title: The role of admission timing in the outcome of intracerebral hemorrhage patients at a specialized stroke center.
abstract: BACKGROUND
  Admission at 'off times' has been suggested to result in increased risk of poor outcome. The utilization of high volume centers may be a potential remedy to this variability in care.
  
  
  OBJECTIVE
  To assess the ability of a high volume center to mitigate variability in care due to timing of admission in a post hoc analysis of an observational study.
  
  
  METHODS
  The medical records of 200 hypertensive intracerebral hemorrhage (ICH) patients admitted to the Neurological Intensive Care Unit (NICU) from 12 January 2009 to 4 April 2013 were identified and examined for variable outcome based on admission timing using the modified Rankin Scale (mRS). Multiple logistic regression was used to assess predictors of poor outcome, correcting severity of admission.
  
  
  RESULTS
  Seventy-five admissions were recorded to have occurred on the weekend. The 3-month follow-up mRS of surviving patients was 3·78 in weekend admissions and 3·63 in weekday admissions (P  =  0·62). One hundred and seven night admissions occurred. The average mRS at 3 months of surviving patients was 3·56 in night admissions and 3·84 in daytime admissions (P  =  0·36). Thirteen patients were admitted in July. The 3-month mRS of surviving patients was 3·71 for July admissions and 3·38 for non-July admissions (P  =  0·58). Only ICH score was found to be a predictor of outcome on multivariate analysis (P < 0·001).
  
  
  CONCLUSIONS
  No significant difference in the outcome of patients was identified regardless of time of admission. High volume centers may be less prone to temporal variability in care, though the existence of temporal variability in care at low volume centers is controversial.
authors.forename: Michael M
authors.initials: MM
authors.lastname: McDowell
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Kellner
authors.forename: Eric S
authors.initials: ES
authors.lastname: Sussman
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Bruce
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Bruce
authors.forename: Simon G
authors.initials: SG
authors.lastname: Heuts
authors.forename: E
authors.initials: E
authors.lastname: Sander Connolly
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006757:Hospital Units; D006801:Humans; D020299:Intracranial Hemorrhage, Hypertensive / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D012720:Severity of Illness Index; D020521:Stroke; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Admission timing,; Intracerebral hemorrhage,; July phenomenon,; Off-hours effect,; Outcome; Weekend effect,