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 H Murad, Henry H. Ting

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

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
Volume25
Issue number4
DOIs
StatePublished - 2014

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Meta-Analysis
Stroke
Mortality
North America
MEDLINE
Cohort Studies
Databases
Delivery of Health Care

Keywords

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

ASJC Scopus subject areas

  • Internal Medicine
  • Medicine(all)

Cite this

Off-hour presentation and outcomes in patients with acute ischemic stroke : A systematic review and meta-analysis. / Sorita, Atsushi; Ahmed, Adil; Starr, Stephanie R.; Thompson, Kristine M.; Reed, Darcy A.; Abu Dabrh, Abd Moain; Prokop, Larry; Kent, David M.; Shah, Nilay D; Murad, Mohammad H; Ting, Henry H.

In: European Journal of Internal Medicine, Vol. 25, No. 4, 2014, p. 394-400.

Research output: Contribution to journalArticle

Sorita, Atsushi ; Ahmed, Adil ; Starr, Stephanie R. ; Thompson, Kristine M. ; Reed, Darcy A. ; Abu Dabrh, Abd Moain ; Prokop, Larry ; Kent, David M. ; Shah, Nilay D ; Murad, Mohammad H ; Ting, Henry H. / Off-hour presentation and outcomes in patients with acute ischemic stroke : A systematic review and meta-analysis. In: European Journal of Internal Medicine. 2014 ; Vol. 25, No. 4. pp. 394-400.
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abstract = "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.",
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AU - Sorita, Atsushi

AU - Ahmed, Adil

AU - Starr, Stephanie R.

AU - Thompson, Kristine M.

AU - Reed, Darcy A.

AU - Abu Dabrh, Abd Moain

AU - Prokop, Larry

AU - Kent, David M.

AU - Shah, Nilay D

AU - Murad, Mohammad H

AU - Ting, Henry H.

PY - 2014

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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.

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KW - Meta-analysis

KW - Modified Rankin Scale

KW - Mortality

KW - Off-hours

KW - Systematic review

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