"Weekend Effect" Raises Risk of Stroke Mortality


TORONTO - Patients who have a stroke are less likely to die within the next week if they are admitted to a hospital on a weekday rather than over the weekend, neurologists in Canada report.

Still, patients should remember: "Time is brain," lead investigator Dr. Gustavo Saposnik said in an American Heart Association press release, "so the sooner the patient seeks medical attention, the higher the chance of better outcome, no matter the day, time or living area."

The so-called "weekend effect" has been documented for other serious conditions," such as a blood clot in the lung or a dangerous expansion of the wall of the aorta, the largest artery in the body, Saposnik, from the University of Toronto, and his associates note in the medical journal Stroke.

However, whether the phenomenon applies to stroke patients has not been fully explored.

Using the Canadian Institute for Health Information's national database, the investigators identified all patients admitted to an acute care hospital after a stroke between April 2003 and March 2004. Included were 26,676 patients admitted to 606 centers across Canada.

The fatality rate over the next 7 days was 7.4 percent among the 20,047 patients admitted on weekdays, and 8.5 percent for the 6,629 patients admitted on weekends. Men and women were equally represented, and the average patient age in both groups was about 75 years.

After taking into account the effects of age, gender, other illnesses and medical complications, patients admitted on weekends had a 17 percent increased risk of death.

The discrepancy was larger in rural hospitals than in urban hospitals, and when the responsible physician was a general practitioner rather than a specialist. Admission to a non-teaching hospital was also associated with increased risk, as was admission to an intensive care unit.

"Even in a country with universal health insurance coverage (such as Canada), disparities in resources, expertise, or the number of healthcare providers working during weekends" may affect the stroke mortality rate, Saposnik and his associates conclude.


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