title: Comprehensive stroke centers and the 'weekend effect': the SPOTRIAS experience.
abstract: OBJECTIVE
  Previous studies have found mortality among ischemic stroke patients to be higher on weekends. We sought to evaluate whether weekend admission was associated with worse outcomes in a large comprehensive stroke center (CSC) cohort.
  
  
  METHODS
  Consecutive ischemic stroke patients presenting within 6 h of symptom onset were identified using the 8 CSC SPOTRIAS (Specialized Programs of Translational Research in Acute Stroke) database. Patients who received intra-arterial therapy or who were enrolled in a nonobservational clinical trial were excluded. All patients meeting the inclusion criteria were then divided into two groups: weekday admissions or weekend admissions. Weekend admission was defined as Friday 17:01 to Monday 08:59. The remainder were classified as weekday admissions. Multivariate logistic regression was used, adjusting for age, stroke severity on admission [according to the National Institutes of Health Stroke Scale (NIHSS)] and admission glucose, in order to compare the outcomes of the weekend versus the weekday groups.
  
  
  RESULTS
  Eight thousand five hundred and eighty-one subjects from the combined SPOTRIAS database were screened from 2002 to 2009; 2,090 (24.4%) of these met the inclusion criteria. There was no significant difference in tissue plasminogen activator treatment rates between the weekday and weekend groups (58.5 vs. 60.4%, p = 0.397). Weekend admission was not a significant independent predictor of inhospital mortality (8.4 vs. 9.9%, p = 0.056), length of stay (4 vs. 5 days, p = 0.442), favorable discharge disposition (38.0 vs. 42.2%, p = 0.122), favorable functional outcome at discharge (41.6 vs. 43.4%, p = 0.805), favorable 90-day functional outcome (54.2 vs. 46.9%, p = 0.301), or 90-day mortality (18.2 vs. 19.8%, p = 0.680) when adjusting for age, NIHSS and admission glucose.
  
  
  CONCLUSIONS
  In this large cohort of ischemic stroke patients treated at CSCs, we did not observe the 'weekend effect.' This may be due to access to stroke specialists 24 h a day on 365 days a year, nurses with stroke experience and the organized system for delivering care that is available at CSCs. These results suggest that EMS protocol should be reexamined regarding the preferential delivery of weekend stroke victims to hospitals that provide all levels of reperfusion therapy. This further highlights the importance of organized stroke care.
authors.affiliation: Health Services and Center for Outcome and Effectiveness Research and Education, University of Alabama at Birmingham, Birmingham, AL 35249-3280, USA. kca@uab.edu
authors.forename: Karen C
authors.initials: KC
authors.lastname: Albright
authors.forename: Sean I
authors.initials: SI
authors.lastname: Savitz
authors.forename: Rema
authors.initials: R
authors.lastname: Raman
authors.forename: Sheryl
authors.initials: S
authors.lastname: Martin-Schild
authors.forename: Joseph
authors.initials: J
authors.lastname: Broderick
authors.forename: Karin
authors.initials: K
authors.lastname: Ernstrom
authors.forename: Andria
authors.initials: A
authors.lastname: Ford
authors.forename: Rakesh
authors.initials: R
authors.lastname: Khatri
authors.forename: Dawn
authors.initials: D
authors.lastname: Kleindorfer
authors.forename: David
authors.initials: D
authors.lastname: Liebeskind
authors.forename: Randolph
authors.initials: R
authors.lastname: Marshall
authors.forename: José G
authors.initials: JG
authors.lastname: Merino
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Meyer
authors.forename: Natalia
authors.initials: N
authors.lastname: Rost
authors.forename: Brett C
authors.initials: BC
authors.lastname: Meyer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D005791:Patient Care; D010351:Patient Discharge; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality; D015996:Survival Rate; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator