Can comprehensive stroke centers erase the 'weekend effect'?
BACKGROUND
Prior epidemiological work has shown higher mortality in ischemic stroke patients admitted on weekends, which has been termed the 'weekend effect'. Our aim was to assess stroke patient outcomes in order to determine the significance of the 'weekend effect' at 2 comprehensive stroke centers.


METHODS
Consecutive stroke patients were identified using prospective databases. Patients were categorized into 4 groups: intracerebral hemorrhage (ICH group), ischemic strokes not treated with IV t-PA (intravenous tissue plasminogen activator; IS group), acute ischemic strokes treated with IV t-PA (AIS-TPA group), and transient ischemic attack (TIA group). Weekend admission was defined as the period from Friday, 17:01, to Monday, 08:59. Patients treated beyond the 3-hour window, receiving intra-arterial therapy, or enrolled in nonobservational clinical trials were excluded. Patient demographics, NIHSS scores, and admission glucose levels were examined. Adverse events, poor functional outcome (modified Rankin scale, mRS, 3-6), and mortality were compared.


RESULTS
A total of 2,211 patients were included (1,407 site 1, 804 site 2). Thirty-six percent (800/2,211) arrived on a weekend. No significant differences were found in the ICH, IS, AIS-TPA, or TIA groups with respect to the rate of symptomatic ICH, mRS on discharge, discharge disposition, 90-day mRS, or 90-day mortality when comparing weekend and weekday groups. Using multivariate logistic regression to adjust for site, age, admission NIHSS, and blood glucose, weekend admission was not a significant independent predictive factor for in-hospital mortality in all strokes (OR = 1.10, 95% CI 0.74-1.63, p = 0.631).


CONCLUSIONS
Our results suggest that comprehensive stroke centers (CSC) may ameliorate the 'weekend effect' in stroke patients. These results may be due to 24/7 availability of stroke specialists, advanced neuroimaging, or ongoing training and surveillance of specialized nursing care available at CSC. While encouraging, these results require confirmation in prospective studies.
Albright
Karen C
KC
Department of Neurosciences, University of California-San Diego, CA, USA.
Raman
Rema
R
Ernstrom
Karin
K
Hallevi
Hen
H
Martin-Schild
Sheryl
S
Meyer
Brett C
BC
Meyer
Dawn M
DM
Morales
Miriam M
MM
Grotta
James C
JC
Lyden
Patrick D
PD
Savitz
Sean I
SI
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000401:mortality / Q000628:therapy; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006757:Hospital Units / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000401:mortality / Q000628:therapy; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012189:Retrospective Studies; D020521:Stroke / Q000401:mortality* / Q000628:therapy*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D000078329:Workforce; D055815:Young Adult
D010959:Tissue Plasminogen Activator