Weekend Effect in Children With Stroke in the Nationwide Inpatient Sample

Abstract

Background and Purpose-Studies have demonstrated differences in clinical outcomes in adult patients with stroke admitted on weekdays versus weekends. The study's objective was to determine whether a weekend impacts clinical outcomes in children with ischemic stroke and hemorrhagic stroke. Methods-Children aged 1 to 18 years admitted to US hospitals from 2002 to 2011 with a primary discharge diagnosis of ischemic stroke or hemorrhagic stroke were identified by International Classification of Disease, 9th Revision, codes. Logistic regression estimated odds ratios and 95% confidence intervals for in-hospital mortality and discharge to a nursing facility among children admitted on weekends (Saturday and Sunday) versus weekdays (Monday to Friday), adjusting for potential confounders. Results-Of 8467 children with ischemic stroke, 28% were admitted on a weekend. Although children admitted on weekends did not have a higher in-hospital mortality rate than those admitted on weekdays (4.1% versus 3.3%; P=0.4), children admitted on weekends had a higher rate of discharge to a nursing facility (25.5% versus 18.6%; P=0.003). After adjusting for age, sex, and confounders, the odds of discharge to a nursing facility remained increased among children admitted on weekends (odds ratio, 1.5; 95% confidence interval, 1.1-1.9; P=0.006). Of 10 919 children with hemorrhagic stroke, 25.3% were admitted on a weekend. Children admitted on weekends had a higher rate of in-hospital mortality (12% versus 8%; P=0.006). After adjusting for age, sex, and confounders, the odds of in-hospital mortality remained higher among children admitted on weekends (odds ratio, 1.4; 95% confidence interval, 1.1-1.9; P=0.04). Conclusions-There seems to be a weekend effect for children with ischemic and hemorrhagic strokes. Quality improvement initiatives should examine this phenomenon prospectively.

Endovascular Therapy in Pediatric Stroke: Utilization, Patient Characteristics, and Outcomes

“…Studies of ischemic stroke in children report incidences ranging from 0.6-7.9/100,000 children per year. 2,3,16,[19][20][21][22][23][24][25][26] Our incidence is consistent with recent studies using similar populations and methods. 22,24 We found endovascular therapy codes in 1% of our AIS cohort.…”

The weekend effect in liver transplantation

“…While studies have shown a weekend effect for different medical conditions (including acute kidney injury [ 4 ], pneumonia [ 5 ] or dysrhythmia [ 6 ]) major commonalities among conditions affected by a weekend effect are the need for time sensitive interventions and care at an intensive care unit. In line with this, there are numerous reports about a weekend effect for stroke [ 7 – 9 ] myocardial infarction [ 10 , 11 ] or pulmonary embolism [ 12 , 13 ]. Additionally, a growing body evidence points towards a weekend effect for conditions requiring emergency surgery e.g.…”

Paediatric outcomes and timing of admission

“…Of those that showed a significant adverse weekend effect, one assessed 19 386 children aged 1–18 years of age in the USA who were admitted with ischaemic or haemorrhagic stroke 5. A limitation of the study was that it relied on the correct coding of the diagnoses in the database 5.…”

“…A limitation of the study was that it relied on the correct coding of the diagnoses in the database 5. Another examined the outcome of 12 893 children older than or equal to 90 days admitted to a rural hospital in Kenya.…”