title: Stroke care organization overcomes the deleterious 'weekend effect' on 1-month stroke mortality: a population-based study.
abstract: OBJECTIVE
  Suffering a stroke during the weekend is associated with a poorer prognosis. The impact of implementing a dedicated stroke care network in Dijon, France, in 2003 on 30-day mortality in strokes/transient ischaemic attacks (TIA) occurring during weekends/bank holidays was evaluated.
  
  
  METHODS
  All cases of stroke and TIA from 1985 to 2010 were identified from a population-based registry, using multiple overlapping sources of information. Demographics and clinical data were recorded. Cox regression models were used to evaluate associations between day of onset (weekdays versus weekends/bank holidays) and 30-day all-cause mortality. Data were stratified according to time periods [before (1985-2003) and after (2004-2010) implementation of the stroke network] and stroke subtypes (ischaemic stroke and intracerebral hemorrhage).
  
  
  RESULTS
  Of the 5864 recorded patients, 1465 (25%) had their event during weekends/bank holidays. Patients with stroke/TIA during weekdays were comparable with those with stroke/TIA during weekends/bank holidays for baseline characteristics. Excess mortality was observed in patients with stroke/TIA during weekends/bank holidays during 1985-2003 (18.2% vs. 14.0%, P < 0.01) but not during 2004-2010 (8.4% vs. 8.3%, P = 0.74). Onset during weekends/bank holidays was associated with a higher risk of 30-day mortality during 1985-2003 (adjusted hazard ratio 1.26; 95% CI 1.06-1.51, P = 0.01), but not during 2004-2010 (adjusted hazard ratio 0.99; 95% CI 0.69-1.43, P = 0.97).
  
  
  CONCLUSIONS
  The deleterious effect of weekends/bank holidays on early stroke mortality disappeared after the organization of a dedicated stroke care network in our community. Our findings provide strong support for the implementation of quality improvement initiatives in order to attenuate inequalities in the management of stroke patients.
authors.affiliation: Dijon Stroke Registry, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, Burgundy, France. ybejot@yahoo.fr
authors.forename: Y
authors.initials: Y
authors.lastname: Béjot
authors.forename: C
authors.initials: C
authors.lastname: Aboa-Eboulé
authors.forename: A
authors.initials: A
authors.lastname: Jacquin
authors.forename: O
authors.initials: O
authors.lastname: Troisgros
authors.forename: M
authors.initials: M
authors.lastname: Hervieu
authors.forename: J
authors.initials: J
authors.lastname: Durier
authors.forename: G-V
authors.initials: GV
authors.lastname: Osseby
authors.forename: M
authors.initials: M
authors.lastname: Giroud
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002545:Brain Ischemia / Q000150:complications / Q000401:mortality / Q000628:therapy; D019058:Community Networks / Q000706:statistics & numerical data*; D003627:Data Interpretation, Statistical; D005260:Female; D005602:France / Q000453:epidemiology; D006693:Holidays; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications / Q000401:mortality / Q000628:therapy; D002546:Ischemic Attack, Transient / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011153:Population; D012044:Regression Analysis; D020521:Stroke / Q000401:mortality* / Q000628:therapy*; D016896:Treatment Outcome
keywords: epidemiology of stroke; outcomes; registry; stroke; stroke care; weekend