Abstract WP37: The Effect of Weekend Admission on Intracerebral Hemorrhage Outcome at High Volume Institutions
INTRODUCTION: Admission for urgent care on weekends has been suggested to result in increased risk of poor outcome. Studies have suggested that admissions for intracerebral hemorrhage (ICH) have resulted in a significant increase in in-hospital mortality on a national level. The utilization of regional, high volume centers specializing in the management of acute stroke may be a potential remedy to this variability in care. We sought to test this hypothesis by examining the outcomes of ICH patients admitted to the Columbia University Medical Center Neurological ICU (NICU).
Methods: The medical records of 229 ICH patients admitted to the NICU from 2009 to 2012 were identified through the Intra-Cerebral Outcomes Project prospective database and examined for weekend versus weekday admission to the NICU, as well as day versus night admission. Multiple logistic regression was used to asses for predictors of in-patient mortality and poor outcome at 3 months, defined as a modified Rankin score of 4 or greater. Outcome measures were corrected for admission severity of presentation and demographics.
Results: Sixty-five admissions were recorded to have occurred on the weekend, with 14 (21.5%) patients dying in hospital. Forty-nine (29.8%) of the 164 weekday admissions resulted in mortality (p=0.27). The 3 month follow up of surviving patients was 3.4 in weekend admissions and 3.1 in weekday admissions (p= 0.93). One hundred and one night admissions occurred, with 30 in-hospital mortalities. One hundred twenty-one patients were admitted during the day shift, with 32 in-patient mortalities occurring (p=0.54). The average outcome at 3 months was 3.0 in night admissions and 3.3 in day-time admissions (p=0.39).
Conclusions: No significant difference in the mortality or 3 month outcome of patients was identified regardless of day or time of admission. This may be secondary to a higher number of weekend and night duty personnel capable of being mobilized during crisis situations compared to other centers, or the increased experience of medical staff in the work up and acute management of ICH patients. When possible, aggressive diversion of patients to high volume, specialized care centers may reduce the risk of variability in care based on time of admission.
- © 2012 by American Heart Association, Inc.