Liu Zeyu, Yang Kaixuan, Gu Hongqiu, Wei Minping, Feng Xianjing, Yu Fang, Du Yang, Li Zixiao, Xia Jian
Department of Neurology, Xiangya Hospital (Z. Liu, M.W., X.F., F.Y., Y.D., J.X.), Central South University, Changsha, Hunan, China.
Clinical Research Center for Cerebrovascular Disease of Hunan Province (Z. Liu, M.W., X.F., F.Y., Y.D., J.X.), Central South University, Changsha, Hunan, China.
Stroke. 2024 May;55(5):1359-1369. doi: 10.1161/STROKEAHA.123.046096. Epub 2024 Mar 28.
The structure and staffing of hospitals greatly impact patient outcomes, with frequent changes occurring during nights and weekends. This retrospective cohort study assessed the impact of admission timing on in-hospital management and outcomes for patients with stroke receiving reperfusion therapy in China using data from a nationwide registry.
Data from patients receiving reperfusion therapy were extracted from the Chinese Stroke Center Alliance. Hospital admission time was categorized according to day/evening versus night and weekday versus weekend. Primary outcomes were in-hospital death or discharge against medical advice, hemorrhage transformation, early neurological deterioration, and major adverse cardiovascular events. Logistic regression was performed to compare in-hospital management performance and outcomes based on admission time categories.
Overall, 42 381 patients received recombinant tissue-type plasminogen activator (r-tPA) therapy, and 5224 underwent endovascular treatment (EVT). Patients admitted during nighttime had a higher probability of receiving r-tPA therapy within 4.5 hours from onset or undergoing EVT within 6 hours from onset compared with those admitted during day/evening hours (adjusted odds ratio, 1.04 [95% CI, 1.01-1.08]; =0.021; adjusted odds ratio, 1.72 [95% CI, 1.59-1.86]; <0.001, respectively). However, no significant difference was observed between weekend and weekday admissions for either treatment. No notable differences were noted between weekends and weekdays or nighttime and daytime periods in door-to-needle time for r-tPA or door-to-puncture time for EVT initiation. Furthermore, weekend or nighttime admission did not have a significant effect on the primary outcomes of r-tPA therapy or EVT. Nevertheless, in patients undergoing EVT, a higher incidence of pneumonia was observed among those admitted at night compared with those admitted during day/evening hours (adjusted odds ratio, 1.22 [95% CI, 1.05-1.42]; =0.011).
Patients admitted at nighttime were more likely to receive r-tPA therapy or EVT within the time window recommended in the guidelines. However, patients receiving EVT admitted at night had an increased risk of pneumonia.
医院的结构和人员配置对患者的治疗结果有很大影响，夜间和周末经常会发生变化。这项回顾性队列研究利用全国登记处的数据，评估了入院时间对中国接受再灌注治疗的中风患者的院内管理和治疗结果的影响。
从中国卒中中心联盟提取接受再灌注治疗患者的数据。医院入院时间根据白天/晚上与夜间以及工作日与周末进行分类。主要结局包括院内死亡或自动出院、出血转化、早期神经功能恶化和主要不良心血管事件。进行逻辑回归以比较基于入院时间分类的院内管理表现和结局。
总体而言，42381例患者接受了重组组织型纤溶酶原激活剂（r-tPA）治疗，5224例接受了血管内治疗（EVT）。与白天/晚上入院的患者相比，夜间入院的患者在发病后4.5小时内接受r-tPA治疗或在发病后6小时内接受EVT的可能性更高（调整后的优势比，1.04[95%CI，1.01-1.08]；P=0.021；调整后的优势比，1.72[95%CI，1.59-1.86]；P<0.001）。然而，两种治疗在周末和工作日入院之间均未观察到显著差异。r-tPA的门到针时间或EVT开始的门到穿刺时间在周末和工作日之间或夜间和白天之间均未观察到显著差异。此外，周末或夜间入院对r-tPA治疗或EVT的主要结局没有显著影响。然而，在接受EVT的患者中，夜间入院的患者肺炎发生率高于白天/晚上入院的患者（调整后的优势比，1.22[95%CI，1.05-1.42]；P=0.011）。
夜间入院的患者更有可能在指南推荐的时间窗内接受r-tPA治疗或EVT。然而，夜间接受EVT的患者肺炎风险增加。
