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Published on: October 15, 2021
Off-Hour Admission Is Associated with Poor Outcome in Patients with Intracerebral Hemorrhage
Muhammad Junaid Akram1, Xinni Lv1, Lan Deng1
1Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
Insights
Intracerebral hemorrhage (ICH) patients admitted during off-hours face a higher risk of poor functional outcomes. This study highlights the importance of timely care for improving stroke patient prognosis.
Area of Science:
- Neurology
- Emergency Medicine
- Public Health
Background:
- Stroke mortality rates are known to increase during off-hours and weekends.
- Intracerebral hemorrhage (ICH) is a severe type of stroke with significant morbidity and mortality.
- Understanding factors influencing ICH patient outcomes is crucial for improving care.
Purpose of the Study:
- To investigate the impact of off-hour admission on the functional outcomes of intracerebral hemorrhage (ICH) patients.
- To determine if admission timing affects patient prognosis after ICH.
- To identify potential disparities in stroke care based on admission time.
Main Methods:
- Retrospective analysis of a prospective cohort of 656 ICH patients admitted between January 2017 and December 2019.
- Inclusion criteria: Acute ICH within 72 hours of onset, baseline CT scan, and 3-month follow-up.
- Multivariable logistic regression was used to analyze the association between off-hour admission and poor functional outcomes, adjusting for confounders.
Main Results:
- 48.5% of patients were admitted during on-hours, and 51.5% during off-hours.
- Off-hour admission was significantly associated with a higher risk of poor functional outcome at 3 months (adjusted OR 2.17, 95% CI 1.35-3.47, p=0.001).
- Patients with poor outcomes had larger hematoma volumes and shorter time from onset to imaging.
Conclusions:
- Admission during off-hours is an independent risk factor for poor functional outcomes in intracerebral hemorrhage patients.
- Healthcare systems should consider strategies to mitigate the negative impact of off-hour admissions on stroke care.
- Ensuring timely and equitable access to stroke care, regardless of admission time, is essential for improving patient prognosis.
Abstract:
The mortality of stroke increases on weekends and during off-hour periods. We investigated the effect of off-hour admission on the outcomes of intracerebral hemorrhage (ICH) patients. We retrospectively analyzed a prospective cohort of ICH patients, admitted between January 2017 and December 2019 at the First Affiliated Hospital of Chongqing Medical University. Acute ICH within 72 h after onset with a baseline computed tomography and 3-month follow-up were included in our study. Multivariable logistic regression analysis was performed for calculating the odds ratios (OR) and 95% confidence interval (CI) for the outcome measurements. Of the 656 participants, 318 (48.5%) were admitted during on-hours, whereas 338 (51.5%) were admitted during off-hours. Patients with a poor outcome had a larger median baseline hematoma volume, of 27 mL (interquartile range 11.1-53.2 mL), and a lower median time from onset to imaging, of 2.8 h (interquartile range 1.4-9.6 h). Off-hour admission was significantly associated with a poor functional outcome at 3 months, after adjusting for cofounders (adjusted OR 2.17, 95% CI 1.35-3.47; p = 0.001). We found that patients admitted during off-hours had a higher risk of poor functional outcomes at 3 months than those admitted during working hours.
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