title: Off-hour effect on 3-month functional outcome after acute ischemic stroke: a prospective multicenter registry.
abstract: OBJECTIVE
  The time of hospital arrival may have an effect on prognosis of various vascular diseases. We examined whether off-hour admission would affect the 3-month functional outcome in acute ischemic stroke patients admitted to tertiary hospitals.
  
  
  METHODS
  We analyzed the 'off-hour effect' in consecutive patients with acute ischemic stroke using multi-center prospective stroke registry. Work-hour admission was defined as when the patient arrived at the emergency department between 8 AM and 6 PM from Monday to Friday and between 8 AM and 1 PM on Saturday. Off-hour admission was defined as the rest of the work-hours and statutory holidays. Multivariable logistic regression was used to analyze the association between off-hour admission and 3-month unfavorable functional outcome defined as modified Rankin Scale (mRS) 3-6. Multivariable model included age, sex, risk factors, prehospital delay time, intravenous thrombolysis, stroke subtypes and severity as covariates.
  
  
  RESULTS
  A total of 7075 patients with acute ischemic stroke were included in this analysis: mean age, 67.5 (±13.0) years; male, 58.6%. In multivariable analysis, off-hour admission was not associated with unfavorable functional outcome (OR, 0.89; 95% CI, 0.72-1.09) and mortality (OR, 1.09; 95% CI, 0.77-1.54) at 3 months. Moreover, off-hour admission did not affect a statistically significant shift of 3-month mRS distributions (OR, 0.90; 95% CI, 0.78-1.05).
  
  
  CONCLUSIONS
  'Off-hour' admission is not associated with an unfavorable 3-month functional outcome in acute ischemic stroke patients admitted to tertiary hospitals in Korea. This finding indicates that the off-hour effects could be overcome with well-organized stroke management strategies.
authors.affiliation: Department of Neurology, Hallym University Sacred Heart Hospital, Chuncheon-si, Republic of Korea.
authors.forename: Chulho
authors.initials: C
authors.lastname: Kim
authors.affiliation: Department of Neurology, Hallym University Sacred Heart Hospital, Chuncheon-si, Republic of Korea.
authors.forename: Min Uk
authors.initials: MU
authors.lastname: Jang
authors.affiliation: Department of Neurology, Hallym University Sacred Heart Hospital, Anyang-si, Republic of Korea.
authors.forename: Mi Sun
authors.initials: MS
authors.lastname: Oh
authors.affiliation: Department of Neurology, Myongji Hospital, Goyang-si, Republic of Korea.
authors.forename: Jong-Ho
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Neurology, Kangnam Sacred Heart Hospital, Seoul, Republic of Korea.
authors.forename: San
authors.initials: S
authors.lastname: Jung
authors.affiliation: Department of Neurology, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea.
authors.forename: Ju-Hun
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Neurology, Hallym University Sacred Heart Hospital, Anyang-si, Republic of Korea.
authors.forename: Kyung-Ho
authors.initials: KH
authors.lastname: Yu
authors.affiliation: Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
authors.forename: Moon-Ku
authors.initials: MK
authors.lastname: Han
authors.affiliation: Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
authors.forename: Beom Joon
authors.initials: BJ
authors.lastname: Kim
authors.affiliation: Department of Neurology, Seoul Medical Center, Seoul, Republic of Korea.
authors.forename: Tai Hwan
authors.initials: TH
authors.lastname: Park
authors.affiliation: Department of Neurology, Seoul Medical Center, Seoul, Republic of Korea.
authors.forename: Sang-Soon
authors.initials: SS
authors.lastname: Park
authors.affiliation: Department of Neurology, Soonchunhyang University Hospital, Seoul, Republic of Korea.
authors.forename: Kyung Bok
authors.initials: KB
authors.lastname: Lee
authors.affiliation: Department of Neurology, Dong-A University Hospital, Busan, Republic of Korea.
authors.forename: Jae Kwan
authors.initials: JK
authors.lastname: Cha
authors.affiliation: Department of Neurology, Dong-A University Hospital, Busan, Republic of Korea.
authors.forename: Dae-Hyun
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Department of Neurology, Yeungnam University Medical Center, Daegu, Republic of Korea.
authors.forename: Jun
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Neurology, College of Medicine, Kangwon National University, Chuncheon-si, Republic of Korea.
authors.forename: Sung-Hun
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Neurology, Eulji University Hospital, Daejeon, Republic of Korea.
authors.forename: Soo Joo
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Department of Neurology, Eulji University Hospital, Daejeon, Republic of Korea.
authors.forename: Youngchai
authors.initials: Y
authors.lastname: Ko
authors.affiliation: Department of Neurology, Eulji General Hospital, Seoul, Republic of Korea.
authors.forename: Jong-Moo
authors.initials: JM
authors.lastname: Park
authors.affiliation: Department of Neurology, Eulji General Hospital, Seoul, Republic of Korea.
authors.forename: Kyusik
authors.initials: K
authors.lastname: Kang
authors.affiliation: Department of Neurology, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.
authors.forename: Young-Jin
authors.initials: YJ
authors.lastname: Cho
authors.affiliation: Department of Neurology, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.
authors.forename: Keun-Sik
authors.initials: KS
authors.lastname: Hong
authors.affiliation: Department of Neurology, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Ki-Hyun
authors.initials: KH
authors.lastname: Cho
authors.affiliation: Department of Neurology, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Joon-Tae
authors.initials: JT
authors.lastname: Kim
authors.affiliation: Department of Neurology, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.
authors.forename: Dong-Eog
authors.initials: DE
authors.lastname: Kim
authors.affiliation: Department of Neurology, Jeju National University Hospital, Jeju-do, Republic of Korea.
authors.forename: Jay Chol
authors.initials: JC
authors.lastname: Choi
authors.affiliation: Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
authors.forename: Myung Suk
authors.initials: MS
authors.lastname: Jang
authors.affiliation: Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
authors.forename: Hee-Joon
authors.initials: HJ
authors.lastname: Bae
authors.affiliation: Department of Neurology, Hallym University Sacred Heart Hospital, Anyang-si, Republic of Korea.
authors.forename: Byung-Chul
authors.initials: BC
authors.lastname: Lee
authors.affiliation: Department of Neurology, Hallym University Sacred Heart Hospital, Chuncheon-si, Republic of Korea.
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator