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November 02, 2010; 75 (18) Articles

Association between weekend hospital presentation and stroke fatality

Jiming Fang, Gustavo Saposnik, Frank L. Silver, Moira K. Kapral, For the Investigators of the Registry of the Canadian Stroke Network
First published November 1, 2010, DOI: https://doi.org/10.1212/WNL.0b013e3181fb84bc
Jiming Fang
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Gustavo Saposnik
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Frank L. Silver
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Moira K. Kapral
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Citation
Association between weekend hospital presentation and stroke fatality
Jiming Fang, Gustavo Saposnik, Frank L. Silver, Moira K. Kapral, For the Investigators of the Registry of the Canadian Stroke Network
Neurology Nov 2010, 75 (18) 1589-1596; DOI: 10.1212/WNL.0b013e3181fb84bc

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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

  • 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.

  • 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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Letters: Rapid online correspondence

  • Association between weekend hospital presentation and stroke fatality
    • Christina Campbell, Acute Care Nurse Practioner, Mayo Clinic, Jacksonville, FLcampbell.christina@mayo.edu
    • Heidi Woessner, William D Freeman
    Submitted March 09, 2011
  • Reply from the authors
    • Moira Kapral, Toronto General Hospital, Toronto General Hospital, 200 Elizabeth St., 14 Eaton North, Room 215, Toronto, Ontario, CanadaMoira.Kapral@uhn.on.ca
    • Jiming Fang, Gustavo Saposnik
    Submitted March 09, 2011
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