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

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.