title: Pulmonary embolism: the weekend effect.
abstract: BACKGROUND
  Pulmonary embolism is a common, often fatal condition that requires timely recognition and rapid institution of therapy. Previous studies have documented worse outcomes for weekend admissions for a variety of time-sensitive medical conditions. This phenomenon has not been clearly demonstrated for pulmonary embolism.
  
  
  METHODS
  We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample for the years 2000 to 2008 to identify people with a principal discharge diagnosis of pulmonary embolism. We classified admissions as weekend if they occurred between midnight Friday and midnight Sunday. We compared all-cause in-hospital mortality between weekend and weekday admissions and investigated the timing of inferior vena cava (IVC) filter placement and thrombolytic infusion as potential explanations for differences in mortality.
  
  
  RESULTS
  Unadjusted mortality was higher for weekend admissions than weekday admissions (OR, 1.19; 95% CI, 1.13-1.24). This increase in mortality remained statistically significant after controlling for potential confounding variables (OR, 1.17; 95% CI, 1.11-1.22). Among patients who received an IVC filter, a larger proportion of those admitted on a weekday than on the weekend received it on their first hospital day (38% vs 29%, P < .001). The timing of thrombolytic therapy did not differ between weekday and weekend admissions.
  
  
  CONCLUSIONS
  Weekend admissions for pulmonary embolism were associated with higher mortality than weekday admissions. Our finding that IVC filter placement occurred later in the hospital course for patients admitted on weekends with pulmonary embolism suggests differences in the timeliness of diagnosis and treatment between weekday and weekend admissions. Regardless of cause, physicians should be aware that weekend admissions for pulmonary embolism have a 20% increased risk of death and warrant closer attention than provided during the week.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Milwaukee, WI. Electronic address: rnanchal@mcw.edu.
authors.forename: Rahul
authors.initials: R
authors.lastname: Nanchal
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Milwaukee, WI.
authors.forename: Gagan
authors.initials: G
authors.lastname: Kumar
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Milwaukee, WI.
authors.forename: Amit
authors.initials: A
authors.lastname: Taneja
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Milwaukee, WI.
authors.forename: Jayshil
authors.initials: J
authors.lastname: Patel
authors.affiliation: Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshmukh
authors.affiliation: Department of Medicine, and Institute for Health and Society, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Sergey
authors.initials: S
authors.lastname: Tarima
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Milwaukee, WI.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Jacobs
authors.affiliation: Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI; Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI.
authors.forename: Jeff
authors.initials: J
authors.lastname: Whittle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D011655:Pulmonary Embolism / Q000401:mortality* / Q000628:therapy*; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D016306:Vena Cava Filters; D055815:Young Adult