Off-hours admission for acute stroke is not associated with worse outcome - a nationwide Israeli stroke project

J. Y. Streifler*, M. Benderly, N. Molshatzki, N. Bornstein, D. Tanne

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background and purpose: Several studies reported worse outcome for stroke patients arriving on weekends. We compared working hours to off-work hours throughout the week as there is lack of experienced staff and special services during off-hours. Methods: A nationwide stroke survey project on acute stroke was carried out in all acute care hospitals in Israel during 2004, 2007 and 2010 (2-month each). 'On-hours' were defined as regular Israel working hours and the rest, including holidays, were defined as 'off-hours'. The modified Rankin scale (mRS) at discharge was used for the main analysis on outcome. Results: A total of 4827 acute strokes patients were analyzed (2139 arrived on-hours and 2688 during off-hours). 'Off-hours' patients were 1year younger (mean 70 vs. 71years in 'on-hours') had lower rates of prior cardiac interventions, but had higher admission blood pressure levels and had more intracerebral hemorrhages (ICH) (11% vs. 8% in 'on-hours' patients, P<0.001). Death during hospitalization was recorded in 9% of 'off-hours' vs. 6% of 'on-hours' patient (P=0.004). Controlling for age, blood pressure, stroke type, pre-stroke mRS, admission NIHSS, and thrombolysis, the relative odds of poor outcome (i.e. mRS≥2) amongst 'off-hours' admissions compared to on-hours was 1.09 (95% CI: 0.92-1.30). Odds ratio amongst ischaemic stroke patients was 1.08 (95% CI: 0.88-1.33). Conclusions: Off-hours stroke admissions were associated with higher short-term mortality rate, probably due to a higher rate of ICH. After controlling for the latter and other potential confounders, 'off-hours' admissions were not different from 'on-hours' with respect to poor outcome.

Original languageEnglish
Pages (from-to)643-647
Number of pages5
JournalEuropean Journal of Neurology
Issue number4
StatePublished - Apr 2012


  • Acute stroke
  • Off-hours
  • Outcome
  • Weekend


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