title: Off-Hour Admission and Outcomes in Patients with Acute Intracerebral Hemorrhage in the INTERACT2 Trial.
abstract: BACKGROUND
  Conflicting data exist of an association between off-hour (weekend, holiday, or night-time) hospital admission and adverse outcome in intracerebral hemorrhage (ICH). We determined the association between off-hour admissions and poor clinical outcome, and of any differential effect of early intensive blood pressure (BP) lowering treatment between off- and on-hour admissions, among participants of the Intensive BP Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2).
  
  
  METHODS
  Subsidiary analysis of INTERACT2, a multinational, multicenter, clinical trial of patients with spontaneous ICH with elevated systolic BP, randomly assigned to intensive (target systolic BP <140 mm Hg) or guideline-based (<180 mm Hg) BP management. Primary outcome was death or major disability (modified Rankin scale of 3-6) at 90 days. Off-hour admission was defined as night-time (4:30 p.m. to 8:30 a.m.) on weekdays, weekends (Saturday and Sunday), and public holidays in each participating country.
  
  
  RESULTS
  Of 2,794 patients with information on the primary outcome, 1,770 (63%) were admitted to study centers during off-hours. Off-hour admission was not associated with risk of poor outcome at 90 days (53% off-hour vs. 55% on-hour; p = 0.49), even after adjustment for comorbid risk factors (odds ratio 0.92; 95% CI 0.76-1.12). Consistency exists in the effects of intensive BP lowering between off- and on-hour admission (p = 0.85 for homogeneity).
  
  
  CONCLUSIONS
  Off-hour admission was not associated with increased risks of death or major disability among trial protocol participants with acute ICH. Intensive BP lowering can provide similar treatment effect irrespective of admission hours.
authors.affiliation: The George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Sato
authors.forename: Hisatomi
authors.initials: H
authors.lastname: Arima
authors.forename: Emma
authors.initials: E
authors.lastname: Heeley
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Hirakawa
authors.forename: Candice
authors.initials: C
authors.lastname: Delcourt
authors.forename: Richard I
authors.initials: RI
authors.lastname: Lindley
authors.forename: Thompson
authors.initials: T
authors.lastname: Robinson
authors.forename: Yining
authors.initials: Y
authors.lastname: Huang
authors.forename: Lewis
authors.initials: L
authors.lastname: Morgenstern
authors.forename: Christian
authors.initials: C
authors.lastname: Stapf
authors.forename: Jiguang
authors.initials: J
authors.lastname: Wang
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
authors.forename: Craig S
authors.initials: CS
authors.lastname: Anderson
mesh_terms: D000208:Acute Disease / Q000628:therapy; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents