Association between weekend hospital presentation and stroke fatality.
BACKGROUND
Previous studies have found higher stroke case fatality in patients admitted to the hospital on weekends compared to weekdays, but the reasons for this association are not known.


METHODS
This was a cohort study using data from the Registry of the Canadian Stroke Network. We included consecutive patients with acute stroke or TIA seen in the emergency department or admitted to the hospital at 11 stroke centers in Ontario, Canada, between July 1, 2003, and March 30, 2008 (n = 20,657). We compared in-hospital stroke care and 7-day all-cause stroke case fatality rates between patients seen on weekends and weekdays, with adjustment for stroke severity and other baseline factors.


RESULTS
Overall rates of hospital presentation were lower on weekends compared to weekdays, with lower rates of weekend presentation among individuals with minor stroke and TIA compared to those with more severe strokes. Stroke care, including admission to a stroke unit, neuroimaging, and dysphagia screening, was similar in those treated on weekends and weekdays. All-cause 7-day fatality rates were higher in patients seen on weekends compared to weekdays (8.1% vs 7.0%), even after adjustment for age, sex, stroke severity, and comorbid conditions (adjusted hazard ratio 1.12, 95% confidence interval 1.00 to 1.25).


CONCLUSIONS
Stroke fatality is higher with weekend compared to weekday admission, even after adjustment for case mix.
Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, Canada.
Jiming
J
Fang
Gustavo
G
Saposnik
Frank L
FL
Silver
Moira K
MK
Kapral
D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006693:Holidays; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling; D020521:Stroke / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D013997:Time Factors