Worse Outcome for Weekend Stroke Admission Confirmed

Case mix more severe on weekends, but adjustment for this factor does not change finding

MONDAY, Nov. 1 (HealthDay News) -- Another study has confirmed that hospital admission for stroke on a weekend is associated with a higher mortality rate than admission on a weekday, but the reasons for this remain unclear, according to research published in the Nov. 2 issue of Neurology.

To compare stroke care and seven-day case fatality rates in patients with weekday versus weekend admission, Jiming Fang, Ph.D., of the Institute for Clinical Evaluative Sciences in Toronto, and colleagues conducted a cohort study of 20,657 consecutive emergency department presentations/hospital admissions for transient ischemic attack (TIA) or acute stroke using a Canadian stroke registry.

The researchers found that overall hospital presentation rates were lower on weekends than weekdays, and there were lower rates of weekend presentation among those with minor stoke and TIA than among those with more severe strokes. Stroke care measures were not significantly different on weekends. After adjustment for stroke severity and other factors, the all-cause seven-day fatality rate hazard ratio was 1.12 for patients admitted on weekends compared to weekdays.

"Our results suggest that the observed association between weekend hospital presentation and stroke fatality is in part explained by differences in case mix, particularly stroke severity," the authors write. "We were also unable to capture less well-defined factors such as the skill and expertise with which stroke assessments and care were delivered. Thus, although we did not document any striking differences in the quality of stroke care on weekends and weekdays, it is likely that the data available to us do not reflect the overall quality of care delivery on weekends versus weekdays, and our findings do not negate the need for initiatives aimed at improving staffing and access to resources on weekends and off hours."

Two of the study authors disclosed advisory board and/or financial relationships with pharmaceutical companies.

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