A multifaceted look at time of admission and its impact on case-fatality among a cohort of ischaemic stroke patients
A multifaceted look at time of admission and its impact on case-fatality among a cohort of ischaemic stroke patients
复制标题
DOI：
10.1136/jnnp.2009.202176
复制
发表时间：
2011-01-01
影响因子：
11
通讯作者：
Arah, Onyebuchi A.
中科院分区：
文献类型：
--
作者：
Ogbu, Uzor C.;Westert, Gert P.;Arah, Onyebuchi A.
目的非工作时间入院与不良结果的风险增加有关，但结果并不一致，可能是由于使用了不同的非工作时间护理措施。我们研究，使用一个单一的条件和日益完善的定义的时间入院，下班时间入院的影响，7天中风case-fatality.Methods我们研究了一个回顾性队列的82 219缺血性中风入院115荷兰医院在2000年和2004年之间。数据来自荷兰医学注册中心，采用多变量多水平logistic回归进行分析。我们调整了变量，如年龄，性别，Charlson-Deyo合并症评分，入院的紧迫性，医院的教学状况和专业的主治医师。结果调整后，我们观察到更高的7天死亡风险，周末入院时相比，平日入院（OR 1.27; 95%CI 1.20至1.34）。周日显示死亡风险最高（OR 1.31; 95% CI 1.20至1.44）。以周一白班为参照，周日和周六白班、周日和周一晚班以及所有夜班的死亡率均增加。夜班OR范围为1.94（95% CI 1.56 - 2.41）-2.14（95% CI 1.74 - 2.63）。与8：00入院相比，我们观察到从午夜到7：00死亡几率增加，从14：00到18：00死亡几率降低。结论在荷兰，周末代表缺血性卒中患者死亡风险增加的时期。然而，这种增加的风险似乎代表了在工作日期间存在的潜在夜间风险的加剧。
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.