The impact of hospital presentation time on stroke outcomes: A nationally representative Irish cohort study.
| dc.contributor.author | Loughlin, Elaine | |
| dc.contributor.author | Gabr, Ahmed | |
| dc.contributor.author | Galvin, Rose | |
| dc.contributor.author | McCormack, Joan | |
| dc.contributor.author | Brych, Olga | |
| dc.contributor.author | O'Donnell, Martin J | |
| dc.contributor.author | Collins, Rónán | |
| dc.contributor.author | Thornton, John | |
| dc.contributor.author | Harbison, Joseph | |
| dc.contributor.author | O'Connor, Margaret | |
| dc.date.accessioned | 2024-10-25T11:12:43Z | |
| dc.date.available | 2024-10-25T11:12:43Z | |
| dc.date.issued | 2024-07-12 | |
| dc.identifier.pmid | 38995918 | |
| dc.identifier.doi | 10.1371/journal.pone.0304536 | |
| dc.identifier.uri | http://hdl.handle.net/10147/643201 | |
| dc.description | Objectives: There is conflicting evidence regarding the outcomes of acute stroke patients who present to hospital within normal working hours ('in-hours') compared with the 'out-of-hours' period. This study aimed to assess the effect of time of stroke presentation on outcomes within the Irish context, to inform national stroke service delivery. Materials and methods: A secondary analysis of data from the Irish National Audit of Stroke (INAS) from Jan 2016 to Dec 2019 was carried out. Patient and process outcomes were assessed for patients presenting 'in-hours' (8:00-17:00 Monday-Friday) compared with 'out-of-hours' (all other times). Results: Data on arrival time were available for 13,996 patients (male 56.2%; mean age 72.5 years), of which 55.7% presented 'out-of-hours'. In hospital mortality was significantly lower among those admitted 'in-hours' (11.3%, n = 534) compared with 'out-of-hours' (12.8%, n = 749); (adjusted Odds Ratio (OR) 0.82; 95% Confidence Interval CI [95% CI] 0.72-0.89). Poor functional outcome at discharge (Modified Rankin Scale ≥ 3) was also significantly lower in those presenting 'in-hours' (adjusted OR 0.79; 95% CI 0.68-0.91). In patients receiving thrombolysis, mean door to needle time was shorter for 'in-hours' presentation at 55.8 mins (n = 562; SD 35.43 mins), compared with 'out-of-hours' presentation at 80.5 mins (n = 736; SD 38.55 mins, p < .001). Conclusion: More than half of stroke patients in Ireland present 'out-of-hours' and these presentations are associated with a higher mortality and a lower odds of functional independence at discharge. It is imperative that stroke pathways consider the 24 hour period to ensure the delivery of effective stroke care, and modification of 'out-of-hours' stroke care is required to improve overall outcomes | en_US |
| dc.language.iso | en | en_US |
| dc.rights | Copyright: © 2024 Loughlin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. | |
| dc.rights | Attribution 4.0 International | * |
| dc.rights.uri | http://creativecommons.org/licenses/by/4.0/ | * |
| dc.subject | ACUTE HOSPITALS | en_US |
| dc.subject | STROKE | en_US |
| dc.subject | PATIENT OUTCOMES | en_US |
| dc.title | The impact of hospital presentation time on stroke outcomes: A nationally representative Irish cohort study. | en_US |
| dc.type | Article | en_US |
| dc.identifier.eissn | 1932-6203 | |
| dc.identifier.journal | PloS one | en_US |
| dc.source.journaltitle | PloS one | |
| dc.source.volume | 19 | |
| dc.source.issue | 7 | |
| dc.source.beginpage | e0304536 | |
| dc.source.endpage | ||
| refterms.dateFOA | 2024-10-25T11:12:44Z | |
| dc.source.country | United States |
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Except where otherwise noted, this item's license is described as Copyright: © 2024 Loughlin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.