Bias in request for medical care and impact on outcome during office and non-office hours in stroke patients

Eur J Neurol. 2009 Oct;16(10):1165-7. doi: 10.1111/j.1468-1331.2009.02656.x. Epub 2009 May 14.


Background and purpose: We compared characteristics and treatment success of ischaemic stroke patients admitted during daytime on working days (office hours) with patients admitted on weekend or nighttime (non-office hours) to test if differences in presentation or restraints of medical care during non-office hours determine outcome in stroke patients.

Methods: We analyzed a prospective stroke registry and grouped patients according to admission on office hours and non-office hours. Clinical state on admission, risk factors, sociodemographic items, complications, place of discharge, and clinical state on discharge were recorded.

Results: A total of 37,396 stroke patients were evaluated. Onset-admission time on Monday was significantly elevated and on weekend significantly reduced. Number of patients with treatment success did not differ between patient groups whilst mortality within 7 days, proportion of embolic stroke, overall mortality and rate of complications where higher in patients admitted during non-office hours, rate of thrombolytic treatment was significantly higher during non-office hours. After adjustment for clinical state and admission latency, risk for severe outcome or death was independent from time of admission.

Conclusion: Considering the fact that stroke patients admitted during non-office hours were in more severe clinical condition we found no differences in outcome. Fear of impaired access to sophisticated treatment options during non-office hours could be dispelled by the fact, that rate of thrombolytic treatment was even higher during night and weekend. Therefore, our data do not confirm a weekend effect or night effect on stroke treatment. Delay in request of medical care of mildly affected patients that suffer from stroke on weekends confirms need for educational efforts.

MeSH terms

  • After-Hours Care
  • Aged
  • Aged, 80 and over
  • Cerebral Infarction / mortality*
  • Cerebral Infarction / therapy*
  • Female
  • Humans
  • Length of Stay
  • Male
  • Patient Admission / statistics & numerical data*
  • Patient Discharge
  • Prospective Studies
  • Registries
  • Risk Factors
  • Time Factors
  • Treatment Outcome