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Higher stroke case fatality in patients admitted to hospital on weekends


Patients admitted to hospital on weekends compared to weekdays have higher stroke case fatalities. New research from the Institute for Clinical Evaluative Sciences (ICES) examines why.

"It is not known if the higher motality seen with weekend admission for stroke is due to differences in care, differences in stroke severity or to other factors. We conducted a cohort study using data from the Registry of the Canadian Stroke Network to compare stroke case fatality in patients presenting to hospitals on weekends versus weekdays, after adjusting for stroke severity," says principal investigator and ICES scientist Moira Kapral.

The hospital-based cohort study of 20,657 consecutive patients with acute stroke or transient ischemic attack (TIA) seen at 11 stroke centres in Ontario, Canada, between July 1, 2003, and March 31, 2008, found that:

  • Patients with mild stroke were less likely to present to hospital on weekends and were more likely to present to hospital on Mondays and Tuesdays, suggesting that patients with minor stroke delayed presentation to hospital until after the weekend.
  • Most aspects of in-hospital stroke care (neuroimaging, thrombolysis, stroke unit care) were similar on weekends and weekdays.
  • All-cause, seven-day fatality rates were higher in patients seen on weekends compared to weekdays (8.1 per cent vs. 7.0 per cent). This was partly explained by greater stroke severity in patients admitted on weekends.

“Our study suggests that in Canada it is still important to increase public awareness that minor stroke and TIA require rapid assessment, even on weekends,” says investigator Jiming Fang.

Author affliations: ICES (J.Fang, G.S Saposnik, M.K.Kapral); Dept. of Medicine, U. of T. (G.S. Saposnik, F.L.Silver, M.K.Kapral); Dept. of Health Policy, Management and Evaluation, U. of T. (G.S Saposnik, M.K.Kapral); Division of General Internal Medicine and Clinical Epidemiology, and Women’s Health Program, UHN (M.K.Kapral); Division of Neurology, UHN (F.L.Silver); Stroke Research Unit, Division of Neurology, Dept.of Medicine, St. Michael’s Hospital (G.Saposnik); Canadian Stroke Network (F.L.Silver, M.K.Kapral).

The study “Association between weekend hospital presentation and stroke fatality” is in the November 2, 2010 issue of Neurology.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

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