Off-hour presentation and outcomes in patients with acute ischemic stroke: A systematic review and meta-analysis

Atsushi Sorita, Adil Ahmed, Stephanie R. Starr, Kristine M. Thompson, Darcy A. Reed, Abd Moain Abu Dabrh, Larry Prokop, David M. Kent, Nilay D. Shah, Mohammad Hassan Murad, Henry H. Ting

Research output: Contribution to journalArticlepeer-review

41 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)394-400
Number of pages7
JournalEuropean Journal of Internal Medicine
Issue number4
StatePublished - Apr 2014


  • Acute ischemic stroke
  • Meta-analysis
  • Modified Rankin Scale
  • Mortality
  • Off-hours
  • Systematic review

ASJC Scopus subject areas

  • Internal Medicine


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