'Weekend Effect' and Stroke
By Matthew E. Fink, MD, Interim Chair and Neurologist- in-Chief, Director, Division of Stroke & Critical Care Neurology, Weill Cornell Medical College and New York Presbyterian Hospital. Dr. Fink reports no financial relationship to this field of study. This article originally appeared in the November issue of Neurology Alert. At that time it was peer reviewed by M. Flint Beal, MD, Anne Parrish Titzel Professor, Department of Neurology and Neuroscience, Weill Cornell Medical Center. Dr. Beal reports no financial relationship to this field of study.
Source: Hoh BL, et al. Effect of weekend compared with weekday stroke admission on thrombolytic use, in-hospital mortality, discharge disposition, hospital charges, and length of stay in the Nationwide Inpatient Sample Database, 2002 to 2007. Stroke 2010; 41:2323-2338.
A stroke "weekend effect" on mortality has been noted in studies reported from countries other than the United States. The authors reviewed the U.S. National Inpatient Sample database from 2002 to 2007 for all emergency room admissions with ICD-9 classifications of acute ischemic stroke, to compare weekend vs. weekday stroke admission incidence of thrombolytic use, inhospital mortality, discharge disposition, hospital charges, and length of stay. Adjustments were made to correct for differences in age, gender, season, median income, payer source, comorbidities, hospital location, teaching status, and hospital size.
There were 599,087 emergency room admissions for ischemic stroke: 439,181 weekday admissions and 159,906 weekend admissions. Compared to weekday admissions, patients with acute ischemic stroke admitted on weekends were slightly more likely to receive thrombolytics (OR = 1.114; P = 0.003), incur higher total hospital charges (effect ratio = 1.001; P < 0.001), and have slightly longer lengths of stay (effect ratio = 1.021; P < 0.001). There was no difference in hospital mortality or disposition at time of discharge.