In their interesting study, Palmer et al1 reported an increased risk for death in stroke patients hospitalized on weekends, with performance indicators significantly lower on weekends. Many studies have investigated the so-called weekend effect for acute diseases and most confirmed an increased risk for death (Table). It seems unlikely that—in different countries and continents with diverse health service organizations—understaffing, less availability of procedures or services, or the presence of inexperienced doctors may be the only possible causes. Temporal risk frames exist for acute cardiovascular diseases,18 with evident preferred times of onset.19-22 For example, patients arriving to the hospital on weekends for acute coronary syndrome are more likely to have a ST-segment–elevation myocardial infarction.23 A combination of either increased clinical severity and less availability of hospital facilities may explain this worldwide phenomenon.
Manfredini R, Manfredini F, Salmi R, Gallerani M. Weekend Admissions and Increased Risk for Mortality: Less Urgent Treatments Only? JAMA Neurol. 2013;70(1):131–133. doi:10.1001/jamaneurol.2013.662
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