Background Patients who are admitted during off-hours (nights and weekends) are thought to have worse outcomes. This might be explained by delayed times to treatment. We sought to determine the effect of off-hour presentation on processes of care and outcomes at a comprehensive stroke center.
Methods We reviewed our prospectively collected endovascular database at a tertiary care academic institution between Sep 2010-Dec 2016. All patients that underwent endovascular therapy for large vessel occlusion acute ischemic stroke were included and categorized into two groups: those arriving during regular hours (weekday 7 AM–7 PM) or off-hours. The 2 groups were then matched for age, baseline NIHSS and glucose levels using a weighted Euclidian distance method. Baseline, procedural, and radiological characteristics, as well as outcome parameters were compared.
Results 926 (463 pairs) patients were included. Patients presenting off-hours had higher rates of hypertension (78.2% vs 66.7%, p<0.01) and longer median time from last-known normal to picture (273 min [167–421] vs 253 [145–472], p=0.04). Other baseline characteristics including comorbidities, NIHSS, ASPECT scores, occlusion site were well balanced. There was no difference between groups in picture to puncture median time (57 min [38–95] vs 52 [36–78], p=0.11) and utilization of CT angiography (p=0.56) or CT perfusion (p=0.82) imaging. Moreover there were no differences between groups in terms of rates of successful reperfusion (mTici 2b-3) (p=0.26), parenchymal hematomas (p=0.12), 90 day good outcomes (mRS 0–2) (p=0.99) or mortality (p=0.52). In multivariate analysis, off-hour presentation was not associated with 90 day good outcome.
Conclusions Our study shows that patients presenting off-hours have similar picture to puncture times and clinical outcomes as those presenting during regular hours.
Disclosures J. Grossberg: 1; C; Georgia Research Alliance. 4; C; NTI. M. Bouslama: None. D. Haussen: None. M. Frankel: None. R. Nogueira: None.
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