A multifaceted look at time of admission and its impact on case-fatality among a cohort of ischaemic stroke patients

Purpose Off-hours admissions have been associated with an increased risk of poor outcomes but results have been inconsistent, possibly due to different measures of off-hours care used. We examined, using a single condition and increasingly refined definitions of time of admission, the effect of off-hours admissions on 7-day stroke case-fatality. Methods We studied a retrospective cohort of 82 219 ischaemic stroke admissions to 115 Dutch hospitals between 2000 and 2004. Data were from the Dutch Medical Register and analysed using multivariable multilevel logistic regression. We adjusted for variables such as age, gender, Charlson-Deyo comorbidity score, urgency of admission, hospital teaching status and speciality of attending physician. Results After adjustment, we observed higher 7-day death risk for weekend admissions when compared to weekday admissions (OR 1.27; 95% CI 1.20 to 1.34). Sunday displayed the highest risk of death (OR 1.31; 95% CI 1.20 to 1.44). With the Monday day-shift as a reference, the death odds were increased during the Sunday and Saturday day-shifts, the evening-shifts on Sunday and Monday, and during all night-shifts. The night-shift ORs ranged from 1.94 (95% CI 1.56 to 2.41) to 2.14 (95% CI 1.74 to 2.63). When compared to admission at 8: 00 we observed increased death odds from midnight until 7: 00 and decreased death odds from 14:00 until 18:00. Conclusions Weekends represent a period of increased death risk for ischaemic stroke patients in the Netherlands. However, this increased risk appears to represent an exacerbation of an underlying night-time risk present during the weekdays