title: Outcome in patients admitted outside regular hospital working hours: does time until regular working hours matter?
abstract: OBJECTIVE
  The aim of this study was to investigate whether stratifying patients according to the time period from admission to the start of regular working hours would help detect a weekend effect in acute stroke patients.
  
  
  METHODS
  Ischemic stroke patients admitted between October 2002 and March 2012 were analyzed. Working hours were defined as 9:00-17:00 on weekdays. Patients were divided into those admitted during working hours (no-wait group) and three other groups according to the time from admission to working hours: ≤24 h (short-wait group), 24-48 h (medium-wait group), and >48 h (long-wait group). The modified Rankin Scale score and mortality at three-months were compared among the groups.
  
  
  RESULTS
  Of 5625 patients, 3323 (59%) were admitted outside working hours. The proportion of patients with an mRS score 0-1 at three-months showed a decreasing trend with the time period before working hours: 47% (no-wait group), 42% (short-wait group), 42% (medium-wait group), and 38% (long-wait group), respectively (P < 0·001). When the no-wait group was used as a reference, the odds ratio for modified Rankin Scale score 0-1 was 0·88 (95% confidence interval, 0·75-1·04) in the short-wait group, 0·86 (0·69-1·07) in the medium-wait group, and 0·67 (0·53-0·85) in the long-wait group after adjusting for sex, age, premorbid mRS score, previous morbidity, stroke severity, and vascular risk factors. Mortality at three-months was not different between the no-wait group and the other groups.
  
  
  CONCLUSIONS
  A weekend effect might be evident if patients were stratified according to the time period from admission until working hours.
authors.affiliation: Stroke Center, Department of Neurology, Saiseikai Kumamoto Hospital, Kumamoto, Japan; Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Nakajima
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Inatomi
authors.forename: Toshiro
authors.initials: T
authors.lastname: Yonehara
authors.forename: Masaki
authors.initials: M
authors.lastname: Watanabe
authors.forename: Yukio
authors.initials: Y
authors.lastname: Ando
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D010343:Patient Admission; D020521:Stroke / Q000401:mortality* / Q000628:therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome
keywords: acute stroke therapy; ischemic stroke; outcome; rehabilitation; stroke facilities; stroke teams