Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan.
Doctoral Degree Program in Artificial Intelligence, Asia University, Taichung, Taiwan.
Curr Neurovasc Res. 2022;19(2):225-231. doi: 10.2174/1567202619666220727094020.
Discussing the quality measurements based on interrupted time series in ischemic stroke, delays are often attributed to weekends effect. This study compared the metrics and outcomes of emergent endovascular thrombectomy (EST) during working hours versus non-working hours in the emergency department of an Asian medical center.
A total of 297 patients who underwent EST between January 2015 and December 2018 were retrospectively included, with 52.5% of patients presenting during working hours and 47.5% presenting during nights, weekends, or holidays.
Patients with diabetes were more in non-working hours than in working hours (53.9% vs. 41.0%; p=0.026). It took longer during nonworking hours than working hours in door-to -image times (13 min vs. 12 min; p=0.04) and door-to-groin puncture times (median: 112 min vs. 104 min; p=0.042). Significant statistical differences were not observed between the two groups in neurological outcomes, including successful reperfusion and complications such as intracranial hemorrhage and mortality. However, the change in National Institute of Health Stroke Scale (NIHSS) scores in 24 hours was better in the working-hour group than in the nonworking-hour group (4 vs. 2; p=0.058).
This study revealed that nonworking-hour effects truly exist in patients who received EST. Although delays in door-to-groin puncture times were noticed during nonworking hours, significant differences in neurological functions and mortality were not observed between working and non-working hours. Nevertheless, methods to improve the process during non-working hours should be explored in the future.
在缺血性脑卒中的基于中断时间序列的质量测量中，延迟通常归因于周末效应。本研究比较了亚洲医学中心急诊科在工作时间和非工作时间进行紧急血管内血栓切除术（EST）的指标和结果。
回顾性纳入了 2015 年 1 月至 2018 年 12 月期间接受 EST 的 297 例患者，其中 52.5%的患者在工作时间就诊，47.5%的患者在夜间、周末或节假日就诊。
非工作时间就诊的患者中糖尿病的比例高于工作时间就诊的患者（53.9%比 41.0%；p=0.026）。非工作时间的门到影像时间（13 分钟比 12 分钟；p=0.04）和门到股动脉穿刺时间（中位数：112 分钟比 104 分钟；p=0.042）比工作时间长。两组患者的神经功能预后（包括成功再灌注和颅内出血、死亡率等并发症）差异无统计学意义。然而，工作时间组患者在 24 小时内 NIHSS 评分的变化优于非工作时间组（4 分比 2 分；p=0.058）。
本研究表明，接受 EST 的患者确实存在非工作时间效应。尽管在非工作时间注意到门到股动脉穿刺时间的延迟，但在神经功能和死亡率方面，工作时间和非工作时间之间没有显著差异。然而，未来应探讨在非工作时间改善流程的方法。
