The role of admission timing in the outcome of intracerebral hemorrhage patients at a specialized stroke center

McDowell, Michael M.; Kellner, Christopher P.; Sussman, Eric S; Bruce, Samuel S.; Bruce, Rachel; Heuts, Simon G.; Connolly, E. Sander

doi:10.1179/1743132813y.0000000263

Cited by 12 publications

(13 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Due to certain uncontrollable reasons, such as the sudden onset of diseases, patients may be admitted to the hospital on off‐hours (weekends and nights). Because of a shortage of staff, lack of experienced clinician expertise, as well as inadequate subspecialty care and therapeutic or diagnostic procedures, off‐hour admission may be associated with increased mortality and other adverse outcomes, which has been called “off‐hour effect.”…”

Section: Introductionmentioning

confidence: 99%

“…Because of a shortage of staff, 1-3 lack of experienced clinician expertise, 4 as well as inadequate subspecialty care 5 and therapeutic 6 or diagnostic procedures, 4 off-hour admission may be associated with increased mortality and other adverse outcomes, which has been called "off-hour effect." 7 In previous studies, mortality has been regarded as a proxy measure to assess hospital performance and quality of care. 8,9 For example, the 30-day mortality rate after acute myocardial infarction, chronic obstructive pulmonary disease, stroke, heart failure, and pneumonia has been used by the Centers for Medicare & Medicaid Services to compare outcomes across different hospitals.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Off‐Hour Admission and Mortality Risk for 28 Specific Diseases: A Systematic Review and Meta‐Analysis of 251 Cohorts

Zhou

Herath

et al. 2016

JAHA

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Off‐Hour Admission and Mortality Risk for 28 Specific Diseases: A Systematic Review and Meta‐Analysis of 251 Cohorts

Zhou

Herath

et al. 2016

JAHA

View full text Add to dashboard Cite

show abstract

“…A ''weekend effect'' in patients with cerebrovascular disease is reported with heterogeneous results. [8][9][10][11][12][13][14][15][16] A study utilized the Nationwide Inpatient Sample (NIS) from 2004 and showed 12% increased risk of death with weekend admissions. 13 A second study using data from Get With the Guidelines-Stroke program also demonstrated 19% increased mortality in weekend admissions among patients with hemorrhagic stroke.…”

Section: Introductionmentioning

confidence: 99%

“…15 Data from a single specialized stroke center identified no such significant ''weekend effect'' among patients with ICH admitted to the neurological intensive care unit. 16 The need for uniform management of ICH was recognized in the last decade with the ''weekend effect'' being well described and accepted as a legitimate phenomenon in 2004. In 2005, the Brain Attack Coalition released a set of ''best practice'' guidelines to address standard of care in management of stroke.…”

Section: Introductionmentioning

confidence: 99%

A Nationwide Analysis of Outcomes of Weekend Admissions for Intracerebral Hemorrhage Shows Disparities Based on Hospital Teaching Status

Patel

Mahajan

Benjo

et al. 2015

The Neurohospitalist

View full text Add to dashboard Cite

Background and Purpose: With the ''weekend effect'' being well described, the Brain Attack Coalition released a set of ''best practice'' guidelines in 2005, with the goal to uniformly provide standard of care to patients with stroke. We attempted to define a ''weekend effect'' in outcomes among patients with intracranial hemorrhage (ICH) over the last decade, utilizing the Nationwide Inpatient Sample (NIS) data. We also attempted to analyze the trend of such an effect. Materials and Methods: We determined the association of ICH weekend admissions with hospital outcomes including mortality, adverse discharge, length of stay, and cost compared to weekday admissions using multivariable logistic regression. We extracted our study cohort from the NIS, the largest all-payer data set in the United States. Results: Of 485 329 ICH admissions from 2002 to 2011, 27.5% were weekend admissions. Overall, weekend admissions were associated with 11% higher odds of in-hospital mortality. When analyzed in 3-year groups, excess mortality of weekend admissions showed temporal decline. There was higher mortality with weekend admissions in nonteaching hospitals persisted (odds ratios 1.16, 1.13, and 1.09, respectively, for 3-year subgroups). Patients admitted during weekends were also 9% more likely to have an adverse discharge (odds ratio 1.09; 95% confidence interval: 1.07-1.11; P < .001) with no variation by hospital status. There was no effect of a weekend admission on either length of stay or cost of care. Conclusion: Nontraumatic ICH admissions on weekends have higher in-hospital mortality and adverse discharge. This demonstrates need for in-depth review for elucidating this discrepancy and stricter adherence to standard-of-care guidelines to ensure uniform care.

show abstract

“…Among the previous studies of ICH, early two studies of a retrospective cohort study of 13821 subjects of NIS 7) and analysis of the GWTG-Stroke program data of 34845 acute hemorrhagic stroke 24) showed the association between off-hour hospital presentation and higher short-term mortality, but most of studies have ever reported no off-hour effect in patients with ICH 6,20,21,26,32) . The Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial of 2794 subjects disclosed off-hour hospital presentation was not related to higher mortality or morbidity in subjects with acute ICH 26) .…”

Section: Discussionmentioning

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

View full text Add to dashboard Cite

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.

show abstract

The role of admission timing in the outcome of intracerebral hemorrhage patients at a specialized stroke center

Abstract: No significant difference in the outcome of patients was identified regardless of time of admission. High volume centers may be less prone to temporal variability in care, though the existence of temporal variability in care at low volume centers is controversial.

Cited by 12 publications

References 19 publications

Off‐Hour Admission and Mortality Risk for 28 Specific Diseases: A Systematic Review and Meta‐Analysis of 251 Cohorts

Off‐Hour Admission and Mortality Risk for 28 Specific Diseases: A Systematic Review and Meta‐Analysis of 251 Cohorts

A Nationwide Analysis of Outcomes of Weekend Admissions for Intracerebral Hemorrhage Shows Disparities Based on Hospital Teaching Status

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

Contact Info

Product

Resources

About