Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association | 2019
Invasiveness and Clinical Outcomes of Off-Hour Admissions in Patients with Intracerebral Hemorrhage.
Abstract
BACKGROUND\nWhether time of hospital admission-during or outside regular working hours-affects functional outcome in intracerebral hemorrhage (ICH) is unestablished as previous analyses have focused on mortality only. We here investigate whether on- versus off-hour hospital admission in ICH is associated with levels of invasiveness and clinical outcomes.\n\n\nMETHODS\nBased on the UKER registry (NCT03183167) we grouped ICH-patients according to on- versus off-hour hospital admission. Primary outcome measures was functional outcome after 3 months using the modified Rankin scale (mRS) dichotomized into favorable (mRS\u202f=\u202f0-3) and unfavorable (mRS\u202f=\u202f4-6). Multivariate regression analyses were used to adjust for baseline imbalances, and subgroup analyses were performed to explore associations of on- versus off-hour admission with invasiveness of therapeutic interventions.\n\n\nRESULTS\nA total of 438/1269 (34.5%) of ICH-patients were admitted during regular working hours. Mortality rates were not significantly different among patients with on- versus off-hour admission. On-hour patients showed a significantly larger proportion of patients with favorable outcome (on-hour: mRS\u202f=\u202f0-3 after 3 months: 176/416 (42.3%) versus off-hour: 265/784 (33.8%); P\u202f=\u202f.004). Analysis of invasive therapeutic interventions revealed that likelihood of favorable outcome was significantly increased among on-hour admitted patients who did not require neurosurgical interventions (no external ventricular drain n\u202f=\u202f349, OR: 1.67[1.13-2.48], P < .05; no hematoma evacuation surgery n\u202f=\u202f423, OR: 1.51[1.07-2.14], P < .05).\n\n\nCONCLUSION\nThis study verified an off-hour effect in ICH that relates to functional outcome, rather than mortality, and which may be linked to different levels of invasive therapeutic interventions in patients admitted during off-hour.