Association between weekend admissions and mortality after aneurysmal subarachnoid hemorrhage: the "weekend effect" revisited
Association between weekend admissions and mortality after aneurysmal subarachnoid hemorrhage: the "weekend effect" revisited
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DOI：
10.3171/2019.1.jns183185
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发表时间：
2020-04-01
影响因子：
4.1
通讯作者：
Macdonald, R. Loch
中科院分区：
文献类型：
--
作者：
Mikhail, Mirriam;Ayling, Oliver G. S.;Macdonald, R. Loch
研究目的：周末或下班后入院的外科和内科患者死亡率较高，这一现象被称为“周末效应”。“作者评估了周末入院是否会导致蛛网膜下腔出血后患者的死亡和长期神经系统结局。方法对克拉生坦克服蛛网膜下腔出血后神经系统缺血和梗死复发（CONSCIOUS-1）研究进行了事后分析。单变量和逐步多变量Logistic回归分析进行评估周末入院和死亡率和长期神经系统outcome.Results的413例受试者包括在CONSCIOUS-1研究，140例患者已在周末入院之间的关联。一个显着的相互作用之间确定周末入院和神经系统分级的介绍，表明谁最初提出了一个穷人级的患者的结果不成比例的影响周末入院。在神经系统分级较差的患者亚组（100例患者中有29例）中，逐步多变量logistic回归发现周末入院与死亡独立相关（OR 6.59，95%CI 1.62-26.88，p = 0.009）。周末入院与长期神经系统outcome.CONCLUSIONS是一个独立的危险因素，死亡后12周内蛛网膜下腔出血的患者提出了一个不良的神经系统分级。需要进一步开展工作，以查明和减少任何调解因素。
OBJECTIVE Higher mortality has been reported with weekend or after-hours patient admission across a wide range of surgical and medical specialties, a phenomenon termed the "weekend effect." The authors evaluated whether weekend admission contributed to death and long-term neurological outcome in patients following aneurysmal subarachnoid hemorrhage.METHODS A post hoc analysis of the Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage (CONSCIOUS-1) study was conducted. Univariable and stepwise multivariable logistic regression analyses were performed to assess the associations between weekend admission and mortality and long-term neurological outcome.RESULTS Of 413 subjects included in the CONSCIOUS-1 study, 140 patients had been admitted during the weekend. A significant interaction was identified between weekend admission and neurological grade on presentation, suggesting that the outcomes of patients who had initially presented with a poor grade were disproportionately influenced by the weekend admission. On stepwise multivariable logistic regression in the subgroup of patients who had presented with a poor neurological grade (29 of 100 patients), admission on the weekend was found to be independently associated with death (OR 6.59, 95% CI 1.62-26.88, p = 0.009). Weekend admission was not associated with long-term neurological outcome.CONCLUSIONS Weekend admission was an independent risk factor for death within 12 weeks following aneurysmal subarachnoid hemorrhage in patients presenting with a poor neurological grade. Further work is required to identify and mitigate any mediating factors.