کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
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3466794 | 1596556 | 2014 | 7 صفحه PDF | دانلود رایگان |
BackgroundStudies have suggested that patients with acute ischemic stroke who present to the hospital during off-hours (weekends and nights) may or may not have worse clinical outcomes compared to patients who present during regular hours.MethodsWe searched Medline In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and Scopus through August 2013, and included any study that evaluated the association between time of patient presentation to a healthcare facility and mortality or modified Rankin Scale in acute ischemic stroke. Quality of studies was assessed with the Newcastle–Ottawa Scale. A random-effect meta-analysis model was applied. Heterogeneity was assessed using the Q statistic and I2. A priori subgroup analyses were used to explain observed heterogeneity.ResultsA total of 21 cohort studies (23 cohorts) with fair quality enrolling 1,421,914 patients were included. Off-hour presentation for patients with acute ischemic stroke was associated with significantly higher short-term mortality (OR, 1.11, 95% CI 1.06–1.17). Presenting at accredited stroke centers (OR 1.04, 95% CI 0.98–1.11) and countries in North America (OR 1.05, 95% CI 1.01–1.09) were associated with smaller increase in mortality during off-hours. The results were not significantly different between adjusted (OR, 1.11, 95% CI 1.05–1.16) and unadjusted (OR, 1.13, 95% CI 0.95–1.35) outcomes. The proportion of patients with modified Rankin Scale at discharge ≥ 2–3 was higher in patients presenting during off-hours (OR, 1.14, 95% CI 1.06–1.22).DiscussionThe evidence suggests that patients with acute ischemic stroke presenting during off-hours have higher short-term mortality and greater disability at discharge.
Journal: European Journal of Internal Medicine - Volume 25, Issue 4, April 2014, Pages 394–400