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Abstract
Background: Previous studies have found higher stroke case fatality in patients admitted to the hospital on weekends compared to weekdays, but the reasons for this association are not known.
Methods: This was a cohort study using data from the Registry of the Canadian Stroke Network. We included consecutive patients with acute stroke or TIA seen in the emergency department or admitted to the hospital at 11 stroke centers in Ontario, Canada, between July 1, 2003, and March 30, 2008 (n = 20,657). We compared in-hospital stroke care and 7-day all-cause stroke case fatality rates between patients seen on weekends and weekdays, with adjustment for stroke severity and other baseline factors.
Results: Overall rates of hospital presentation were lower on weekends compared to weekdays, with lower rates of weekend presentation among individuals with minor stroke and TIA compared to those with more severe strokes. Stroke care, including admission to a stroke unit, neuroimaging, and dysphagia screening, was similar in those treated on weekends and weekdays. All-cause 7-day fatality rates were higher in patients seen on weekends compared to weekdays (8.1% vs 7.0%), even after adjustment for age, sex, stroke severity, and comorbid conditions (adjusted hazard ratio 1.12, 95% confidence interval 1.00 to 1.25).
Conclusions: Stroke fatality is higher with weekend compared to weekday admission, even after adjustment for case mix.
Footnotes
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Study funding: Supported by the Canadian Stroke Network. The Registry of the Canadian Stroke Network is funded by the Canadian Stroke Network and by the Ontario Ministry of Health and Long-Term Care. The Institute for Clinical Evaluative Sciences is supported by an operating grant from the Ontario Ministry of Health and Long-Term Care. The funding agencies had no role in the design or conduct of the study or the collection, management, analysis, or interpretation of the data. The manuscript was reviewed and approved by the publications committee of the Registry of the Canadian Stroke Network.
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- CI
- confidence interval
- RCSN
- Registry of the Canadian Stroke Network
- Received March 11, 2010.
- Accepted July 13, 2010.
- Copyright © 2010 by AAN Enterprises, Inc.
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