Outcome measures.

Objectives
There is conflicting evidence regarding the outcomes of acute stroke patients who present to hospital within normal working hours (‘in-hours’) compared with the ‘out-of-hours’ period. This study aimed to assess the effect of time of stroke presentation on outcomes within the Irish context, to inform national stroke service delivery.
Materials and methods
A secondary analysis of data from the Irish National Audit of Stroke (INAS) from Jan 2016 to Dec 2019 was carried out. Patient and process outcomes were assessed for patients presenting ‘in-hours’ (8:00–17:00 Monday-Friday) compared with ‘out-of-hours’ (all other times).
Results
Data on arrival time were available for 13,996 patients (male 56.2%; mean age 72.5 years), of which 55.7% presented ‘out-of-hours’. In hospital mortality was significantly lower among those admitted ‘in-hours’ (11.3%, n = 534) compared with ‘out-of-hours’ (12.8%, n = 749); (adjusted Odds Ratio (OR) 0.82; 95% Confidence Interval CI [95% CI] 0.72–0.89). Poor functional outcome at discharge (Modified Rankin Scale ≥ 3) was also significantly lower in those presenting ‘in-hours’ (adjusted OR 0.79; 95% CI 0.68–0.91). In patients receiving thrombolysis, mean door to needle time was shorter for ‘in-hours’ presentation at 55.8 mins (n = 562; SD 35.43 mins), compared with ‘out-of-hours’ presentation at 80.5 mins (n = 736; SD 38.55 mins, p < .001).
Conclusion
More than half of stroke patients in Ireland present ‘out-of-hours’ and these presentations are associated with a higher mortality and a lower odds of functional independence at discharge. It is imperative that stroke pathways consider the 24 hour period to ensure the delivery of effective stroke care, and modification of ‘out-of-hours’ stroke care is required to improve overall outcomes.

研究目的：现有研究针对正常工作时段（In-hours，即周一至周五8:00-17:00）就诊的急性脑卒中（acute stroke）患者与非工作时段（Out-of-hours，即其余所有时段）就诊患者的临床结局存在相悖证据。本研究旨在评估爱尔兰场景下脑卒中就诊时间对患者结局的影响，为全国脑卒中医疗服务的规范化开展提供决策依据。

材料与方法：本研究对2016年1月至2019年12月的爱尔兰全国脑卒中审计研究（Irish National Audit of Stroke, INAS）数据开展二次分析。对比了正常工作时段与非工作时段就诊患者的患者结局与诊疗流程结局，其中正常工作时段定义为周一至周五8:00-17:00，其余时段均归为非工作时段。

结果：本研究共纳入13996例具备就诊时间数据的患者（男性占比56.2%；平均年龄72.5岁），其中55.7%的患者于非工作时段就诊。正常工作时段入院患者的院内死亡率为11.3%（n=534），显著低于非工作时段患者的12.8%（n=749）；校正后比值比（adjusted Odds Ratio, OR）为0.82，95%置信区间（95% Confidence Interval, 95% CI）为0.72~0.89。出院时功能预后不良（改良Rankin量表（Modified Rankin Scale）评分≥3）的比例在正常工作时段就诊患者中同样显著更低，校正OR为0.79，95% CI为0.68~0.91。在接受溶栓治疗（thrombolysis）的患者中，正常工作时段就诊者的门-针时间（door to needle time，即患者到院至静脉溶栓给药的时间）更短，平均为55.8分钟（n=562；标准差（standard deviation, SD）35.43分钟），而非工作时段就诊者的平均门-针时间为80.5分钟（n=736；SD 38.55分钟，p < 0.001）。

结论：爱尔兰境内超过半数的脑卒中患者于非工作时段就诊，此类就诊模式与更高的院内死亡率以及出院时功能独立的概率降低显著相关。脑卒中诊疗路径必须覆盖全24小时时段，以确保提供高效的脑卒中救治服务，且亟需优化非工作时段的脑卒中诊疗流程，从而改善整体临床结局。