Longing for Monday Morning? Time Period From Admission Until Working Hours and Stroke Prognosis in K-PLUS Registry.

Background: When considering weekend effect or off-hour effect, time period from admission to regular hospital working hours might affect stroke prognosis more strongly than the timing of admission. We investigated whether admission time until working hours affects clinical prognosis using a regional multicenter stroke registry. Methods: We recruited data from the stroke registry ‘K-PLUS,’ between 2013 and 2017. Acute stroke patients admitted within 24 hours from the last time to be well were included. Patients with premorbid modified Rankin Scale (mRS) score of 3 or more were excluded. Working hours were defined as 9:00-17:00 on weekdays. Patients were divided into those admitted during working hours (WH group) and two other groups according to the time from admission to working hours: within 24 hours (short-wait group), over 24 hours (long-wait group). In-hospital complications and the mRS score at discharge were compared among the groups. Results: Out of 4,729 participants, 2,912 (62%) were admitted outside working hours. Although in-hospital pneumonia after stroke occurred more frequently in the long-wait group (10%) than in the other groups (7%), mortality was not different among the 3 groups. The proportion of patients with mRS score 0-1 at discharge showed a decreasing trend with the time period before working hours: 37% in the WH group, 34% in the short-wait group, and 31% in the long-wait group (p< 0.001). When the WH group was used as a reference, the odds ratio for mRS score 0-1 was 0.86 (95% confidence interval, 0.73-0.93) in the short-wait group and 0.78 (0.65-0.93) in the long-wait group, respectively, after adjusting for other factors including age, stroke severity, and thrombolytic therapy. Conclusion: Our regional multicenter stroke registry demonstrated the evidence that acute stroke patients admitted before 24 hours or more until the regular hospital working hours have poor prognosis.