Abstract
Introduction:
Previous studies have yielded inconsistent results on whether weekend admission impacts the utilization of EVT and IV-rtPA. There is limited data available of whether age groups difference affects on use of IV-rtPA and EVT admitted during the off-hours. Our study aimed to investigate whether admission during the off-hours has any effect on the EVT & IV-rtPA utilization and is distributed uniformly across all age groups?
Method:
All adults admitted to US hospitals from 2005-2015 with a primary diagnosis AIS (n=4,520,516) were identified from the Nationwide Inpatient Sample using ICD-9 CM codes. Discharge weights were used to generate national estimates. On-hours vs. off-hours were defined using the weekend variable. Age groups were divided into 18-39, 40-59, 60-79 and ≥80 years. An age groupwise multivariable logistic regression models were used to compare odds of EVT and IV-rtPA use between on-hours vs. off-hours.
Result:
Total 4.5 million AIS population comprised 2.1% of 18-39 years, 20.0% of 40-59 years, 44.1% of 60-79 years and 34.0% of ≥80 years. Off-hours admissions comprised 25.7% of total AIS. Univariate analysis of off-hours vs. on-hours effects showed EVT utilization was 2.2% vs. 2.3% (P=0.50) and IV-tPA use was 7.9% vs. 7.3% (P=0.18) in 18-39 years. In 40-59 years age group, EVT 1.19% vs. 1.17% (P=0.74) and IV-tPA 6.2% vs. 5.7% (P <0.0001). In 60-79 years, EVT 0.95% vs. 0.96% (P=0.87) and IV-tPA 5.5% vs. 5.0% (P <0.0001) and in ≥80 years, EVT was 0.5% vs. 0.6% (P=0.12) and IV-tPA was 4.7% vs. 4.4% (P <0.0001). After a multivariable adjustment of patients and hospital characteristics, odds of EVT utilization was 0.85 (P=0.18) in 18-39 years, 0.92 (P=0.13) in 40-59 years, 0.91 (P=0.014) in 60-79 years and 0.84 (P=0.003) in ≥80 years. While in IV-tPA group, odds of IV-tPA use was 1.09 (P=0.16) in 18-39 years, 1.08 (P=0.001) in 40-59 years, 1.09 (P <0.0001) in 60-79 years and 1.07 (P=0.002) in ≥80 years.
Conclusion:
Our study concludes that there is a lower rate of EVT performed during off-hours in the age groups of 60-79 and ≥ 80 years old. However, There was no difference reported in the use of EVT in the younger population. It’s also interesting to note that there is a higher use of IV-rtPA during the off-hours in all age groups except age group 18-39 years.