Unfavorable Neurological Outcome among Patients Admitted during On-Call Hours (P06.251)

Abstract

Objective: We assessed the relation between hospital admission during on-call hours and two outcome measures: in hospital mortality (IHM) and neurological deterioration (ND) during hospital stay. Background Acute ischemic stroke admissions during weekends are associated with an increased mortality. It is unclear whether adverse outcome is also more frequent among patients admitted during on-call hours. Design/Methods: We assessed a consecutive cohort of ischemic stroke patients admitted between 01/01/2007 and 12/31/2010. Admission during on-call hours was defined as that occurring during weekends and between 8pm and 8am on weekdays. We defined ND as a difference of ≥ 4 points between the National Institutes of Health Stroke Scale (NIHSS) score on admission and upon discharge. We compared risk factors, comorbidities, neuroimaging results, and outcome measures in patients admitted during on-call and non-on-call hours. We assessed the effect of arriving during on-call hours on IHM and ND by using multiple logistic regression analysis (MLRA), adjusted for age, sex, brain infarct size, and severity of ischemic stroke. Results: We included 229 patients, 82 admitted during on-call hours (35.8%, 95% CI 29.9-42.2). Twenty patients experienced ND (8.7%, 95% CI 5.7-13.1) and 16 died during hospital stay (7.0% CI 95% 4.4-11.1). Patients arriving during on-call hours had more severe strokes (NIHSS 7.7 ± 7.0 vs. 5.3 ± 5.7, p=.008) and a higher proportion of new onset atrial fibrillation (13.4 vs. 5.4%, p=.036), and ND (15.9 vs. 4.8%, p=.004). In the MLRA, admission during on-call hours was associated with ND (OR 3.1, 95% CI 1.1-8.6, p=.024), but not with IHM. Conclusions: Stroke patients admitted during on-call hours had more severe strokes and higher frequency of new onset atrial fibrillation and ND. Admission during on-call hours was associated with ND, regardless the severity of the ischemic stroke, age, sex, and brain infarct size. Admission during on-call hours was not associated with IHM. Disclosure: Dr. Riccio has nothing to disclose. Dr. Sposato has nothing to disclose. Dr. Sposato has nothing to disclose. Dr. Sposato has nothing to disclose. Dr. Sposato has nothing to disclose. Dr. Sposato has nothing to disclose. Dr. Sposato has nothing to disclose. Dr. Sposato has nothing to disclose.