Kim Taikwan, Jwa Cheolsu
Department of Neurosurgery, Incheon Hospital 21, Incheon, Korea.
Department of Neurosurgery, National Medical Center, Seoul, Korea.
J Korean Neurosurg Soc. 2021 Jan;64(1):51-59. doi: 10.3340/jkns.2020.0127. Epub 2020 Dec 4.
Several studies have reported inconsistent findings among countries on whether off-hour hospital presentation is associated with worse outcome in patients with acute stroke. However, its association is yet not clear and has not been thoroughly studied in Korea. We assessed nationwide administrative data to verify off-hour effect in different subtypes of acute stroke in Korea.
We respectively analyzed the nationwide administrative data of National Emergency Department Information System in Korea; 7144 of ischemic stroke (IS), 2424 of intracerebral hemorrhage (ICH), and 1482 of subarachnoid hemorrhage (SAH), respectively. "Off-hour hospital presentation" was defined as weekends, holidays, and any times except 8:00 AM to 6:00 PM on weekdays. The primary outcome measure was in-hospital mortality in different subtypes of acute stroke. We adjusted for covariates to influence the primary outcome using binary logistic regression model and Cox's proportional hazard model.
In subjects with IS, off-hour hospital presentation was associated with unfavorable outcome (24.6% off hours vs. 20.9% working hours, p<0.001) and in-hospital mortality (5.3% off hours vs. 3.9% working hours, p=0.004), even after adjustment for compounding variables (hazard ratio [HR], 1.244; 95% confidence interval [CI], 1.106-1.400; HR, 1.402; 95% CI, 1.124-1.747, respectively). Off-hours had significantly more elderly ≥65 years (35.4% off hours vs. 32.1% working hours, p=0.029) and significantly more frequent intensive care unit admission (32.5% off hours vs. 29.9% working hours, p=0.017) than working hours. However, off-hour hospital presentation was not related to poor short-term outcome in subjects with ICH and SAH.
This study indicates that off-hour hospital presentation may lead to poor short-term morbidity and mortality in patients with IS, but not in patients with ICH and SAH in Korea. Excessive death seems to be ascribed to old age or the higher severity of medical conditions apart from that of stroke during off hours.
多项研究报告了不同国家之间关于非工作时间前往医院就诊是否与急性中风患者的更差预后相关的不一致结果。然而，其关联尚不清楚，且在韩国尚未得到充分研究。我们评估了全国范围的行政数据，以验证韩国不同亚型急性中风的非工作时间影响。
我们分别分析了韩国国家急诊科信息系统的全国行政数据；缺血性中风（IS）患者7144例、脑出血（ICH）患者2424例和蛛网膜下腔出血（SAH）患者1482例。“非工作时间前往医院就诊”定义为周末、节假日以及工作日上午8:00至下午6:00以外的任何时间。主要结局指标是不同亚型急性中风的院内死亡率。我们使用二元逻辑回归模型和Cox比例风险模型对影响主要结局的协变量进行了调整。
在IS患者中，即使在对复合变量进行调整后（风险比[HR]分别为1.244；95%置信区间[CI]为1.106 - 1.400；HR为1.402；95% CI为1.124 - 1.747），非工作时间前往医院就诊仍与不良结局（非工作时间为24.6%，工作时间为20.9%，p<0.001）和院内死亡率（非工作时间为5.3%，工作时间为3.9%，p = 0.004）相关。与工作时间相比，非工作时间≥65岁的老年人明显更多（非工作时间为35.4%，工作时间为32.1%，p = 0.029），重症监护病房入院频率也明显更高（非工作时间为32.5%，工作时间为29.9%，p = 0.017）。然而，非工作时间前往医院就诊与ICH和SAH患者的短期不良结局无关。
本研究表明，在韩国，非工作时间前往医院就诊可能导致IS患者短期发病率和死亡率升高，但对ICH和SAH患者则不然。非工作时间的额外死亡似乎归因于老年或除中风外医疗状况的更高严重程度。
