Weekend Admission in Patients with Acute Ischemic Stroke Is Not Associated with Poor Functional Outcome than Weekday Admission

Abstract

Background and PurposeStroke requires consistent care, but there is concern over the "weekend effect", whereby a weekend admission results in a poor outcome. Our aim was to determine the impact of weekend admission on clinical outcomes in patients with acute ischemic stroke in Korea.MethodsThe outcomes of patients admitted on weekdays and weekends were compared by analyzing data from a prospective outcome registry enrolling 1247 consecutive patients with acute ischemic stroke admitted to four neurology training hospitals in South Korea between September 2004 and August 2005. The primary outcome was a poor functional outcome at 3 months, defined as modified Rankin Scale (mRS) of 3-6. Secondary outcomes were 3-month mortality, use of thrombolysis, complication rate, and length of hospitalization. Shift analysis was also performed to compare overall mRS distributions.ResultsOn weekends, 334 (26.8%) patients were admitted. Baseline characteristics were comparable between the weekday and weekend groups except for more history of heart disease and shorter admission time in weekend group. Univariate analysis revealed poor functional outcome at 3 months, 3-month mortality, complication rate, and length of hospitalization did not differ between the two groups. In addition, overall mRS distributions were comparable (p=0.865). After adjusting for baseline factors and stroke severity, weekend admission was not associated with poor functional outcome at 3 months (adjusted odds ratio, 1.05; 95% CI, 0.74-1.50). Furthermore, none of secondary endpoints differed between the two groups in multivariate analysis.ConclusionsWeekend admission was not associated with poor functional outcome than weekday admission in patients with acute ischemic stroke in this study. The putative weekend effect should be explored further by considering a wider range of hospital settings and hemorrhagic stroke.

Stroke unit care in germany: the german stroke registers study group (ADSR)

“…Data on quality of care on weekends are heterogeneous. Most studies demonstrate a poorer quality of care, and negative effects for patients being admitted on weekends [ 18 – 21 ], whereas others do not confirm these findings [ 22 – 24 ].…”

Outcome in Patients Admitted outside Regular Hospital Working Hours: Does Time until Regular Working Hours Matter?

“…Second, it was found that a longer time period from admission until the next WHs was related only to mRS score 0–1, but not related to mRS score 0–2 or death at three-months on multivariate analysis. Since previous studies selected mRS score 0–1 at discharge or mRS score 0–2 and mortality at three-months as indicators of patient outcomes (Table 4) (1–3,6,8,9,11–19), it was difficult to compare the present results with them. The explanation for the present results is unclear.…”

“…Another possible explanation is that stroke type, specifically ischemic stroke only, affected the negative results for the outcome of mRS score 0–2 or mortality. It has been reported that the absolute effect of off-hours admission was stronger in hemorrhagic stroke than in ischemic stroke (4), and most of the studies that focused on ischemic stroke did not find a significant weekend effect (Table 4) (13–17).…”

“…These issues relevant to delayed rehabilitation or testing could result from lack of staffing levels, as indicated in previous studies (1,3,9,13). Our facility was staffed by stroke physicians 24/7/365 to maintain the quality of medical care regardless of the time period, as in other comprehensive stroke centers (11–16,18). However, despite such efforts, the actual numbers of physicians and other staff, including nurses and rehabilitation staff, were lower outside WHs.…”

“…The higher threshold for admission during the weekend, which is possibly related to higher stroke severity, might also be the cause (6). On the other hand, some researchers indicated that comprehensive stroke centers might overcome the issue (11)(12)(13)(14)(15)(16)(17)(18).…”