title: The effect of weekends and holidays on stroke outcome in acute stroke units.
abstract: OBJECTIVE
  In almost all acute stroke units in Japan, staffing level is lower on weekends and holidays and rehabilitative services are provided only on weekdays. We sought to investigate the effects of low-volume care early after stroke resulting from weekends and holidays on the outcome of stroke.
  
  
  METHODS
  Patients with completed stroke within 72 h of onset were prospectively registered by 10 acute stroke units in Japan. Main outcome measures were favorable outcomes as indicated by a score of 0-1 on the modified Rankin scale (mRS01) on their 21st hospital day and at discharge and case fatality during the hospital stay. Cox proportional hazardsmodels were used to identify the effects of weekday admission and a weekday ratio (a number of weekdays / total length of hospital stay, or 21 days if hospitalization was longer than 21 days) on the main outcome measures.
  
  
  RESULTS
  In a total of 1,134 patients, Cox proportional hazards regression analyses demonstrated that the weekday admission was significantly associated with mRS01 at discharge (hazard ratio, HR: 1.385, 95% CI: 1.087-1.764) and case fatality (HR: 0.477, 95% CI: 0.285-0.798). In 858 patients with rehabilitative therapy, the weekday ratio was significantly associated with mRS01 at discharge (p = 0.014). Compared with the lowest tertile of weekday ratio (<66.6%), the highest tertile (>71.4%) was significantly positively associated with mRS01 at discharge (HR: 1.524, 95% CI: 1.053-2.206; p < 0.026).
  
  
  CONCLUSIONS
  Weekday admission was an independent negative predictor of case fatality and a positive predictor of favorable outcome (mRS01) at discharge from acute stroke units. In patients with rehabilitative therapy, a reduction in the weekday ratio was also associated with unfavorable outcome, probably due to a reduction in multidisciplinary care.
authors.affiliation: Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Osaka, Japan. yazhase@hsp.ncvc.go.jp
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hasegawa
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Yoneda
authors.forename: Satoshi
authors.initials: S
authors.lastname: Okuda
authors.forename: Ryuzo
authors.initials: R
authors.lastname: Hamada
authors.forename: Akihiro
authors.initials: A
authors.lastname: Toyota
authors.forename: Jun
authors.initials: J
authors.lastname: Gotoh
authors.forename: Manabu
authors.initials: M
authors.lastname: Watanabe
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Okada
authors.forename: Kiyonobu
authors.initials: K
authors.lastname: Ikeda
authors.forename: Seturo
authors.initials: S
authors.lastname: Ibayashi
mesh_terms: D000208:Acute Disease; D000368:Aged; D005260:Female; D006282:Health Personnel / Q000458:organization & administration / Q000706:statistics & numerical data; D006693:Holidays / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006757:Hospital Units / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration / Q000706:statistics & numerical data*; D020521:Stroke / Q000401:mortality / Q000628:therapy*; D000071939:Stroke Rehabilitation