TY - JOUR
T1 - Off-hour presentation and outcomes in patients with acute ischemic stroke
T2 - A systematic review and meta-analysis
AU - Sorita, Atsushi
AU - Ahmed, Adil
AU - Starr, Stephanie R.
AU - Thompson, Kristine M.
AU - Reed, Darcy A.
AU - Dabrh, Abd Moain Abu
AU - Prokop, Larry
AU - Kent, David M.
AU - Shah, Nilay D.
AU - Murad, Mohammad Hassan
AU - Ting, Henry H.
PY - 2014/4
Y1 - 2014/4
N2 - Background Studies have suggested that patients with acute ischemic stroke who present to the hospital during off-hours (weekends and nights) may or may not have worse clinical outcomes compared to patients who present during regular hours. Methods We searched Medline In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and Scopus through August 2013, and included any study that evaluated the association between time of patient presentation to a healthcare facility and mortality or modified Rankin Scale in acute ischemic stroke. Quality of studies was assessed with the Newcastle-Ottawa Scale. A random-effect meta-analysis model was applied. Heterogeneity was assessed using the Q statistic and I2. A priori subgroup analyses were used to explain observed heterogeneity. Results A total of 21 cohort studies (23 cohorts) with fair quality enrolling 1,421,914 patients were included. Off-hour presentation for patients with acute ischemic stroke was associated with significantly higher short-term mortality (OR, 1.11, 95% CI 1.06-1.17). Presenting at accredited stroke centers (OR 1.04, 95% CI 0.98-1.11) and countries in North America (OR 1.05, 95% CI 1.01-1.09) were associated with smaller increase in mortality during off-hours. The results were not significantly different between adjusted (OR, 1.11, 95% CI 1.05-1.16) and unadjusted (OR, 1.13, 95% CI 0.95-1.35) outcomes. The proportion of patients with modified Rankin Scale at discharge ≥ 2-3 was higher in patients presenting during off-hours (OR, 1.14, 95% CI 1.06-1.22). Discussion The evidence suggests that patients with acute ischemic stroke presenting during off-hours have higher short-term mortality and greater disability at discharge.
AB - Background Studies have suggested that patients with acute ischemic stroke who present to the hospital during off-hours (weekends and nights) may or may not have worse clinical outcomes compared to patients who present during regular hours. Methods We searched Medline In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and Scopus through August 2013, and included any study that evaluated the association between time of patient presentation to a healthcare facility and mortality or modified Rankin Scale in acute ischemic stroke. Quality of studies was assessed with the Newcastle-Ottawa Scale. A random-effect meta-analysis model was applied. Heterogeneity was assessed using the Q statistic and I2. A priori subgroup analyses were used to explain observed heterogeneity. Results A total of 21 cohort studies (23 cohorts) with fair quality enrolling 1,421,914 patients were included. Off-hour presentation for patients with acute ischemic stroke was associated with significantly higher short-term mortality (OR, 1.11, 95% CI 1.06-1.17). Presenting at accredited stroke centers (OR 1.04, 95% CI 0.98-1.11) and countries in North America (OR 1.05, 95% CI 1.01-1.09) were associated with smaller increase in mortality during off-hours. The results were not significantly different between adjusted (OR, 1.11, 95% CI 1.05-1.16) and unadjusted (OR, 1.13, 95% CI 0.95-1.35) outcomes. The proportion of patients with modified Rankin Scale at discharge ≥ 2-3 was higher in patients presenting during off-hours (OR, 1.14, 95% CI 1.06-1.22). Discussion The evidence suggests that patients with acute ischemic stroke presenting during off-hours have higher short-term mortality and greater disability at discharge.
KW - Acute ischemic stroke
KW - Meta-analysis
KW - Modified Rankin Scale
KW - Mortality
KW - Off-hours
KW - Systematic review
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U2 - 10.1016/j.ejim.2014.03.012
DO - 10.1016/j.ejim.2014.03.012
M3 - Article
C2 - 24721584
AN - SCOPUS:84899968599
SN - 0953-6205
VL - 25
SP - 394
EP - 400
JO - European Journal of Internal Medicine
JF - European Journal of Internal Medicine
IS - 4
ER -