ArticlePloS one2014
The effect of out of hours presentation with acute stroke on processes of care and outcomes: analysis of data from the Stroke Improvement National Audit Programme (SINAP).
Article in PloS one, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
22 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Association of Off-Hour Admission With Treatment Delay and Unfavorable Outcomes in Patients With Stroke: A Systematic Review and Meta-Analysis.Journal of the American Heart Association · 2026Pooled it
- The weekend effect: does hospital mortality differ by day of the week? A systematic review and meta-analysis.BMC health services research · 2018Pooled it
- Temporal structures that determine consistency and quality of care: a case study in hyperacute stroke services.BMJ quality & safety · 2024Article
- The impact of hospital presentation time on stroke outcomes: A nationally representative Irish cohort study.PloS one · 2024Article
- Effect of admission time on provision of acute stroke treatment at stroke units and stroke centers-An analysis of the Swiss Stroke Registry.European stroke journal · 2022Article
- Hyperacute stroke thrombolysis via telemedicine: a multicentre study of performance, safety and clinical efficacy.BMJ open · 2022Observational
- Presentation outside office hours does not negatively influence treatment times for reperfusion therapy for acute ischemic stroke.Journal of neurology · 2021Observational
- Distance Neurological Supervision Using Telestroke Does Not Increase Door-to-Needle Time in Acute Ischemic Stroke Management: The Experience of Two Regional Stroke Units.Frontiers in neurology · 2021Article
- Impact of Off-Hour Hospital Presentation on Mortality in Different Subtypes of Acute Stroke in Korea : National Emergency Department Information System Data.Journal of Korean Neurosurgical Society · 2021Article
- Factors related to time of stroke onset versus time of hospital arrival: A SITS registry-based study in an Egyptian stroke center.PloS one · 2020Article
- Weekend admissions and mortality for major acute disorders across England and Wales: record linkage cohort studies.BMC health services research · 2019Article
- The weekend effect revisited: evidence from the Upper Austrian stroke registry.The European journal of health economics : HEPAC : health economics in prevention and care · 2019Article
- "Weekend Effect" on 30-Day Readmissions among Stroke Survivors: An Analysis of the National Readmission Database.Cerebrovascular diseases extra · 2019Article
- Recommendations for Endovascular Care of Stroke Patients.Interventional neurology · 2018Article
- Weekend admission and mortality for gastrointestinal disorders across England and Wales.The British journal of surgery · 2017Article
- Stroke unit care in germany: the german stroke registers study group (ADSR).BMC neurology · 2017Article
- Diurnal Variation of Intravenous Thrombolysis Rates for Acute Ischemic Stroke and Associated Quality Performance Parameters.Frontiers in neurology · 2017Article
- "Weekend effect" on stroke mortality revisited: Application of a claims-based stroke severity index in a population-based cohort study.Medicine · 2016Observational
- Long-term outcome of severe herpes simplex encephalitis: a population-based observational study.Critical care (London, England) · 2015Observational
- Quality of post arrest care does not differ by time of day at a specialized resuscitation center.Medicine · 2015Observational
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
backgroundThere is inconsistent evidence that patients with stroke admitted to hospital out of regular working hours (such as weekends) experience worse outcomes. We aimed to identify if inequalities in the quality of care and mortality exist in contemporary stroke care in England.
methodsSINAP is a prospective database of acute stroke patients, documenting details of processes of care over the first 72 hours. We compared quality of care indicators and mortality at 72 hours, 7 days and 30 days, for patients who arrived within normal hours (Monday-Friday 8am to 6pm) and for those who arrived out of hours, using multivariable logistic and Cox proportional hazard models. Quality of care was defined according to time from arrival at hospital to interventions (e.g., brain scan), and whether the patient received therapeutic interventions (such as thrombolysis).
results45,726 stroke patients were admitted to 130 hospitals in England between 1 April 2010 and 31 January 2012. Patients admitted out of hours (n = 23779) had more features indicative of worse prognosis (haemorrhagic stroke, reduced consciousness, pre stroke dependency). Out of hours admission was significantly associated with longer delays in receiving a CT scan or being admitted to a stroke unit, and reduced odds of receiving thrombolysis. After adjusting for casemix, there was no consistent evidence of higher mortality for patients admitted out of hours, but patients admitted at the weekends had a higher risk of 30 day mortality (OR 1.14, 95% CI 1.06-1.21).
conclusionInequalities in the provision of stroke care for people admitted out of regular hours persist in contemporary stroke in England. The association with mortality is small and largely attributable to higher illness severity in patients admitted out of hours.
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