title: A Nationwide Analysis of Outcomes of Weekend Admissions for Intracerebral Hemorrhage Shows Disparities Based on Hospital Teaching Status.
abstract: OBJECTIVE
  With the "weekend effect" being well described, the Brain Attack Coalition released a set of "best practice" guidelines in 2005, with the goal to uniformly provide standard of care to patients with stroke. We attempted to define a "weekend effect" in outcomes among patients with intracranial hemorrhage (ICH) over the last decade, utilizing the Nationwide Inpatient Sample (NIS) data. We also attempted to analyze the trend of such an effect.
  
  
  METHODS
  We determined the association of ICH weekend admissions with hospital outcomes including mortality, adverse discharge, length of stay, and cost compared to weekday admissions using multivariable logistic regression. We extracted our study cohort from the NIS, the largest all-payer data set in the United States.
  
  
  RESULTS
  Of 485 329 ICH admissions from 2002 to 2011, 27.5% were weekend admissions. Overall, weekend admissions were associated with 11% higher odds of in-hospital mortality. When analyzed in 3-year groups, excess mortality of weekend admissions showed temporal decline. There was higher mortality with weekend admissions in nonteaching hospitals persisted (odds ratios 1.16, 1.13, and 1.09, respectively, for 3-year subgroups). Patients admitted during weekends were also 9% more likely to have an adverse discharge (odds ratio 1.09; 95% confidence interval: 1.07-1.11; P < .001) with no variation by hospital status. There was no effect of a weekend admission on either length of stay or cost of care.
  
  
  CONCLUSIONS
  Nontraumatic ICH admissions on weekends have higher in-hospital mortality and adverse discharge. This demonstrates need for in-depth review for elucidating this discrepancy and stricter adherence to standard-of-care guidelines to ensure uniform care.
authors.affiliation: Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Achint A
authors.initials: AA
authors.lastname: Patel
authors.affiliation: Department of Neurology, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Abhimanyu
authors.initials: A
authors.lastname: Mahajan
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Ochsner Clinic Foundation, New Orleans, LA, USA.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Benjo
authors.affiliation: Department of Public Health, New York Medical College, Valhalla, NY.
authors.forename: Ambarish
authors.initials: A
authors.lastname: Pathak
authors.affiliation: Neurology Consultants of Huntsville, Huntsville, AL, USA.
authors.forename: Jitesh
authors.initials: J
authors.lastname: Kar
authors.affiliation: Department of Neurology, Michigan State University, East Lansing, MI, USA.
authors.forename: Vishal B
authors.initials: VB
authors.lastname: Jani
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Narender
authors.initials: N
authors.lastname: Annapureddy
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Arkansas Medical Sciences, Little Rock, AR, USA.
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Agarwal
authors.affiliation: Department of Internal Medicine, St. Luke's Roosevelt Medical Center at Mount Sinai, New York, NY, USA.
authors.forename: Manpreet S
authors.initials: MS
authors.lastname: Sabharwal
authors.affiliation: Department of Internal Medicine, St. Luke's Roosevelt Medical Center at Mount Sinai, New York, NY, USA.
authors.forename: Priya K
authors.initials: PK
authors.lastname: Simoes
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Konstantinidis
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Rabi
authors.initials: R
authors.lastname: Yacoub
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Ochsner Clinic Foundation, New Orleans, LA, USA.
authors.forename: Fahad
authors.initials: F
authors.lastname: Javed
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Georges
authors.initials: G
authors.lastname: El Hayek
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Madhav C
authors.initials: MC
authors.lastname: Menon
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Girish N
authors.initials: GN
authors.lastname: Nadkarni
keywords: epidemiology; general neurology; intracerebral hemorrhage; neurohospitalist; stroke and cerebrovascular disease