Association of Off‐Hour Admission With Treatment Delay and Unfavorable Outcomes in Patients With Stroke: A Systematic Review and Meta‐Analysis

BACKGROUND: Despite numerous efforts to reduce the elevated mortality rate of patients with stroke admitted to the hospital during weekends or nights, it remains unclear whether the off-hour treatment has been improved. We aim to assess the treatment delay and outcomes of patients with stroke admitted to the hospital during off-hours. METHODS: Searches were conducted of PubMed, Embase, Medline, and Web of Science from inception to July 2022. Cohort studies reporting the door-to-treatment time, short-term mortality rate, and 90-day function of adult patients with stroke admitted to the hospital on weekends or at night were included. A random-effect meta-analysis model was applied to pool the odds ratio (OR) and mean difference with 95% CI. RESULTS: A total of 84 studies were included. Treatment delay on weekends or nights was significant, with extended door-to-needle time (mean difference, 5.93 [95% CI, 1.88-9.98] minutes) and door-to-groin time (mean difference, 13.54 [95% CI, 5.02-22.06] minutes). Off-hour patients were less likely to receive intravenous thrombolysis within 60 minutes (OR, 0.65 [95% CI, 0.46-0.92]). Off-hour admission was associated with an increased short-term mortality rate for patients with ischemic stroke (OR, 1.07 [95% CI, 1.03-1.11]), intracerebral hemorrhage (OR, 1.10 [95% CI, 1.03-1.18]), and subarachnoid hemorrhage (OR, 1.05 [95% CI, 1.02-1.09]). CONCLUSIONS: This review indicates that off-hour admission was associated with treatment delay and increased risk of stroke death. Patients with stroke admitted on weekends and nights may require more attention, especially those with more severe and complex conditions.