Off‐hour admission and impact on neurological outcome in endovascular treatment for acute ischemic stroke

Hendén, Pia Löwhagen; Rentzos, Alexandros; Karlsson, Jan‐Erik; Rosengren, Lars; Oras, Jonatan; Ricksten, Sven‐Erik

doi:10.1111/aas.13241

Cited by 9 publications

(2 citation statements)

References 24 publications

(37 reference statements)

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“…After title/abstract screening and full-text assessment, a total of 19 studies comprising 14,185 AIS patients receiving EVT were included in the meta-analysis. 3,4,10,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Among those patients, 7174 patients presented/were treated during off-hour and 7011 during working hours. Baseline characteristics of all studies are presented in Table 1, and the overview of this meta-analysis is illustrated in Figure 2.…”

Section: Study Selection and Evaluationmentioning

confidence: 99%

Off-hour effect on time metrics and clinical outcomes in endovascular treatment for large vessel occlusion: A systematic review and meta-analysis

Zha

Yang

Liu

et al. 2021

International Journal of Stroke

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Background There is an ongoing debate on the off-hour effect on endovascular treatment (EVT) for acute large vessel occlusion (LVO). Aims This meta-analysis aimed to compare time metrics and clinical outcomes of acute LVO patients who presented/were treated during off-hour with those during working hours. Summary of review Structured searches on the PubMed, Embase, Web of Science, and Cochrane Library databases were conducted through February 23rd, 2021. The primary outcomes were onset to door, door to imaging, door to puncture, puncture to recanalization, procedural time, successful recanalization, symptomatic intracerebral hemorrhage (SICH), mortality in hospital, good prognosis (90-day modified Rankin Scale [mRS] score 0-2), and 90-day mortality. The secondary outcomes were imaging to puncture, onset to puncture, onset to recanalization, door to recanalization time, mRS 0-2 at discharge, and consecutive 90-day mRS score. The odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI) of the outcomes were calculated using random-effect models. Heterogenicity and publication bias were analyzed. Subgroup and sensitivity analyses were conducted as appropriate. Nineteen studies published between 2014 and 2021 with a total of 14185 patients were eligible for quantitative synthesis. Patients in the off-hour group were significantly younger than those in the on-hour group and with comparable stroke severity and intravenous thrombolysis rate. The off-hour group had longer onset to door (WMD [95%CI], 12.83 [1.84-23.82] min), door to puncture (WMD [95%CI], 11.45 [5.93-16.97] min), imaging to puncture (WMD [95%CI], 10.39 [4.61-16.17] min), onset to puncture (WMD [95%CI], 25.30 [13.11-37.50] min), onset to recanalization (WMD [95%CI], 25.16 [10.28-40.04] min), and door to recanalization (WMD [95%CI], 18.02 [10.01-26.03] min) time. Significantly lower successful recanalization rate (OR [95%CI], 0.85 [0.76-0.95]; P=0.004; I2=0%) was detected in the off-hour group. No significant difference was noted regarding SICH and prognosis. But a trend towards lower OR of good prognosis was witnessed in the off-hour group (OR [95%CI], 0.92 [0.84-1.01]; P=0.084; I2=0%). Conclusions Patients who presented/were treated during off-hour were associated with excessive delays before the initiation of EVT, lower successful reperfusion rate, and a trend towards worse prognosis when compared with working hours. Optimizing the workflows of EVT during off-hour is needed.

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Section: Study Selection and Evaluationmentioning

confidence: 99%

Off-hour effect on time metrics and clinical outcomes in endovascular treatment for large vessel occlusion: A systematic review and meta-analysis

Zha

Yang

Liu

et al. 2021

International Journal of Stroke

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“…https://doi.org/10.3340/jkns.2020.0127 hospital presentation after acute stroke. Off-hours may also increase time interval from computed tomography (CT) scanning to interventional procedure 17) . Because specialists are usually at home during off hours, fast decision-making and subsequent intervention or operation may be delayed 25) .…”

mentioning

confidence: 99%

Impact of Off-Hour Hospital Presentation on Mortality in Different Subtypes of Acute Stroke in Korea : National Emergency Department Information System Data

Kim

Jwa

2021

J Korean Neurosurg Soc

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Objective : Several studies have reported inconsistent findings among countries on whether off-hour hospital presentation is associated with worse outcome in patients with acute stroke. However, its association is yet not clear and has not been thoroughly studied in Korea. We assessed nationwide administrative data to verify off-hour effect in different subtypes of acute stroke in Korea. Methods : We respectively analyzed the nationwide administrative data of National Emergency Department Information System in Korea; 7144 of ischemic stroke (IS), 2424 of intracerebral hemorrhage (ICH), and 1482 of subarachnoid hemorrhage (SAH), respectively. "Off-hour hospital presentation" was defined as weekends, holidays, and any times except 8:00 AM to 6:00 PM on weekdays. The primary outcome measure was in-hospital mortality in different subtypes of acute stroke. We adjusted for covariates to influence the primary outcome using binary logistic regression model and Cox's proportional hazard model. Results : In subjects with IS, off-hour hospital presentation was associated with unfavorable outcome (24.6% off hours vs. 20.9% working hours, p<0.001) and in-hospital mortality (5.3% off hours vs. 3.9% working hours, p=0.004), even after adjustment for compounding variables (hazard ratio [HR], 1.244; 95% confidence interval [CI], 1.106-1.400; HR, 1.402; 95% CI, 1.124-1.747, respectively). Off-hours had significantly more elderly ≥65 years (35.4% off hours vs. 32.1% working hours, p=0.029) and significantly more frequent intensive care unit admission (32.5% off hours vs. 29.9% working hours, p=0.017) than working hours. However, off-hour hospital presentation was not related to poor short-term outcome in subjects with ICH and SAH. Conclusion : This study indicates that off-hour hospital presentation may lead to poor short-term morbidity and mortality in patients with IS, but not in patients with ICH and SAH in Korea. Excessive death seems to be ascribed to old age or the higher severity of medical conditions apart from that of stroke during off hours.

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Mechanical thrombectomy for ischaemic stroke in the anterior circulation: off-hours effect

et al. 2020

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Off‐hour admission and impact on neurological outcome in endovascular treatment for acute ischemic stroke

Abstract: Stroke admittance during off-hours is associated with longer time interval from CT examination to vessel recanalization. The study highlights the need of logistic improvement and probably more resources off-hour in order to deliver an effective stroke care around the clock.

Cited by 9 publications

References 24 publications

Off-hour effect on time metrics and clinical outcomes in endovascular treatment for large vessel occlusion: A systematic review and meta-analysis

Off-hour effect on time metrics and clinical outcomes in endovascular treatment for large vessel occlusion: A systematic review and meta-analysis

Impact of Off-Hour Hospital Presentation on Mortality in Different Subtypes of Acute Stroke in Korea : National Emergency Department Information System Data

Mechanical thrombectomy for ischaemic stroke in the anterior circulation: off-hours effect

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