The effect of weekends and holidays on stroke outcome in acute stroke units
The effect of weekends and holidays on stroke outcome in acute stroke units
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DOI：
10.1159/000087932
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发表时间：
2005-01-01
影响因子：
2.9
通讯作者：
Ibayashi, S
中科院分区：
文献类型：
--
作者：
Hasegawa, Y;Yoneda, Y;Ibayashi, S
背景和目的：在日本几乎所有的急性中风病房中，周末和假期的人员配备水平较低，仅在工作日提供康复服务。我们试图调查中风后早期因周末和假期而进行的低量护理对中风结局的影响。方法：在日本的10个急性卒中单位前瞻性登记发病72小时内的完全性卒中患者。主要结局指标为住院第21天和出院时改良兰金量表（mRS 01）评分为0 - 1的良好结局以及住院期间的病死率。考克斯比例风险模型用于确定工作日入院和工作日比率（工作日数/住院总时间，或如果住院时间超过21天，则为21天）对主要结局指标的影响。结果如下：在总计1，134例患者中，考克斯比例风险回归分析表明，工作日入院与出院时mRS 01（风险比，HR：1.385，95% CI：1.087 - 1.764）和病死率（HR：0.477，95% CI：0.285 - 0.798）显著相关。在858例接受康复治疗的患者中，工作日比率与出院时的mRS 01显著相关（p = 0.014）。与工作日比率的最低三分位数（< 66.6%）相比，出院时最高三分位数（>71.4%）与mRS 01显著正相关（HR：1.524，95% CI：1.053 - 2.206; p < 0.026）。结论：工作日入院是病死率的独立负预测因子，是急性卒中单元出院时良好结局的正预测因子（mRS 01）。在接受康复治疗的患者中，工作日比率的降低也与不良结局相关，这可能是由于多学科护理的减少。版权所有（C）2005 S. Karger AG，巴塞尔。
Background and Purpose: In almost all acute stroke units in Japan, staffing level is lower on weekends and holidays and rehabilitative services are provided only on weekdays. We sought to investigate the effects of low-volume care early after stroke resulting from weekends and holidays on the outcome of stroke. Methods: Patients with completed stroke within 72 h of onset were prospectively registered by 10 acute stroke units in Japan. Main outcome measures were favorable outcomes as indicated by a score of 0 - 1 on the modified Rankin scale (mRS01) on their 21st hospital day and at discharge and case fatality during the hospital stay. Cox proportional hazards models were used to identify the effects of weekday admission and a weekday ratio ( a number of weekdays / total length of hospital stay, or 21 days if hospitalization was longer than 21 days) on the main outcome measures. Results: In a total of 1,134 patients, Cox proportional hazards regression analyses demonstrated that the weekday admission was significantly associated with mRS01 at discharge ( hazard ratio, HR: 1.385, 95% CI: 1.087 -1.764) and case fatality ( HR: 0.477, 95% CI: 0.285 - 0.798). In 858 patients with rehabilitative therapy, the weekday ratio was significantly associated with mRS01 at discharge ( p = 0.014). Compared with the lowest tertile of weekday ratio ( < 66.6%), the highest tertile (>71.4%) was significantly positively associated with mRS01 at discharge ( HR: 1.524, 95% CI: 1.053 - 2.206; p < 0.026). Conclusions: Weekday admission was an independent negative predictor of case fatality and a positive predictor of favorable outcome ( mRS01) at discharge from acute stroke units. In patients with rehabilitative therapy, a reduction in the weekday ratio was also associated with unfavorable outcome, probably due to a reduction in multidisciplinary care. Copyright (C) 2005 S. Karger AG, Basel.