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Original Contribution
January 2010

Hospital Care for Patients Experiencing Weekend vs Weekday Stroke: A Comparison of Quality and Aggressiveness of Care

Author Affiliations

Author Affiliations: Department of Health Professions, Medical University of South Carolina, Charleston.

Arch Neurol. 2010;67(1):39-44. doi:10.1001/archneurol.2009.286
Abstract

Background  We examined the quality and aggressiveness of care for the treatment of acute ischemic stroke (AIS) on weekends vs weekdays. Acute ischemic stroke is a leading cause of death and disability in the United States, and aggressive treatment must be provided within 3 hours for optimal patient outcomes. Because of this short treatment window for the administration of tissue plasminogen activator, patients need around-the-clock access to high-quality and aggressive care.

Objective  To determine whether there is a difference in the quality or aggressiveness of care for patients experiencing AIS on weekends vs weekdays.

Design  Retrospective study.

Setting  Academic research.

Patients  We conducted a retrospective study of patients with AIS in Virginia. Two logistic regression analyses assessed the relationship between weekend admission and quality and aggressiveness of care, while controlling for appropriate patient-level and hospital-level control variables. A propensity score stratification approach controlled for selection bias.

Main Outcome Measures  Treatment with tissue plasminogen activator and in-hospital mortality.

Results  Patients with AIS admitted on weekends are more likely to receive tissue plasminogen activator than those admitted on weekdays (P < .05). No statistically significant difference was noted in patient mortality based on day of admission (P ≥ .05). We detected no difference in the likelihood to seek hospital care on weekends between patients with AIS vs patients with hemorrhagic stroke.

Conclusions  Patients experiencing AIS are more likely to receive tissue plasminogen activator on weekends than on weekdays. Patients experiencing AIS who are admitted on weekends are no more likely to die than those who are admitted on weekdays. Further research is necessary to understand differences in weekend vs weekday care.

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