Weekends: A Dangerous Time for Having a Stroke?

Abstract

Background and Purpose-Weekend admissions are associated with higher in-hospital mortality. However, limited information is available concerning the "weekend effect" on stroke mortality. Our aim was to evaluate the impact of weekend admissions on stroke mortality in different settings. Methods-We analyzed all hospital admissions for ischemic stroke from April 2003 to March 2004 through the Hospital Morbidity Database. The Hospital Morbidity Database is a national database that contains patient-level sociodemographic, diagnostic, procedural, and administrative information including all acute care facilities across Canada. The major inclusion criterion was admission to an acute care facility with a principal diagnosis of ischemic stroke. Clinical variables and facility characteristics were included in the analysis. Results-Overall, 26 676 patients were admitted to 606 hospitals for ischemic stroke. Weekend admissions comprised 6629 (24.8%) of all admissions. Seven-day stroke mortality was 7.6%. Weekend admissions were associated with a higher stroke mortality than weekday admissions (8.5% vs 7.4%; odds ratio, 1.17; 95% CI, 1.06 to 1.29). Mortality was similarly affected among patients admitted to rural versus urban hospitals or when the most responsible physician was a general practitioner versus specialist. In the multivariable analysis, weekend admissions were associated with higher early mortality (odds ratio, 1.14; 95% CI, 1.02 to 1.26) after adjusting for age, sex, comorbidities, and medical complications. Conclusions-Stroke patients admitted on weekends had a higher risk-adjusted mortality than did patients admitted on weekdays. Disparities in resources, expertise, and healthcare providers working during weekends may explain the observed differences in weekend mortality.

Factors Associated with Pneumonia Outcomes: A Nationwide Population-Based Study over the 1997–2008 Period

“…The finding of the relationship between weekend admissions and higher mortality is similar to the results of Foss and Kehlet regarding hip fracture 36 19,37 . Disparities in medical resources, expertise or staffing levels for nurses as well as for physicians during weekends may exist in Taiwan 19 .…”

Association of a higher density of specialist neuroscience providers with fewer deaths from stroke in the United States population

“…8,9,28 Recent studies have demonstrated increased stroke-related mortality during the weekends, potentially due to the decreased availability of specialized care providers. 20,32 The "weekend effect" has been eliminated in comprehensive centers with around-the-clock availability of neurologists, neurosurgeons, and intensivists. 1,29 This is in agreement with the observed positive effect of more neuroscience providers in decreasing stroke mortality rates in the current analysis.…”

Mortality in out-of-hours emergency medical admissions – more than just a weekend effect

“…This effect is also true when considering only deaths within the first two days of admission. [1][2][3] In large studies, mortality has also been reported to be increased for weekend admissions with specific medical conditions such as myocardial infarction, 4 heart failure, 5 upper gastrointestinal bleeding, 6,7 pulmonary embolism, 8 stroke 9 and intracerebral haemorrhage, 10 although a single-centre UK study of six specific medical conditions failed to demonstrate this effect. 11 Worse outcomes have been reported for patients admitted outside normal working hours with myocardial infarction 12 and in 'night-time' (6 pm-8 am) admissions to some intensive care units.…”