Patients who are hospitalized for stroke during a weekend have a higher risk of dying compared to those admitted from Monday to Friday, say Canadian researchers in an article published in the peer-reviewed medical journal Neurology. Risk of death is linked to weekends, regardless of how severe the stroke is.

A stroke is a condition in which blood flow to an area of the brain is interrupted, either because of a blood clot or a ruptured artery or blood vessel. Not enough vital oxygen and glucose reach a part of the brain, leading to brain cell death and brain damage. Surviving patients may have problems with speech, movement, continence, and memory. There are two main types of stroke. Ischemic stroke and hemorrhagic stroke. 75% of all stroke cases are ischemic stroke – a blood clot (thrombus) forms, blocking blood flow to a part of the brain. A hemorrhagic stroke is when a blood vessel on the brain’s surface ruptures, filling that area of the brain and skull with blood (subarachnoid hemorrhage), or when a faulty artery in the brain bursts and fills the surrounding tissue with blood (cerebral hemorrhage).

Moira K. Kapral, MD, who was with the Institute for Clinical Evaluative Sciences in Ontario during the study, said:

We wanted to test whether the severity of strokes on weekends compared to weekdays would account for lower survival rates on the weekends. Our results suggest that stroke severity is not necessarily the reason for this discrepancy.

The researchers examined five-years’ worth of information on 20,657 acute stroke patients from 11 Ontario centers from the Canadian Stroke Network. They only included patients with a first stroke in their study.

Those with severe or moderate stroke had an equal chance of becoming hospitalized on a weekday or weekend. However, individuals with a mild stroke were more likely to be admitted on a weekday, the authors wrote. They found that the weekend patients were a little bit older and more likely to get to the hospital by ambulance – they were also more likely to be in hospital sooner after stroke symptoms started, compared to other stroke patients.

8.1% of stroke victims admitted to hospital during a weekend died within seven days of having a stroke, compared to 7% for those admitted on a weekday. Even after taking into account several factors which could influence results, such as age, sex, severity of the stroke, and other medical conditions/illnesses, as well as the use of blood-thinning medications, the results were the same – weekend people had a higher risk of dying within a week.

Kapral said:

Stroke is not the only condition in which lower survival rates have been linked for people admitted to hospitals on the weekends. The reason for the differences in rates could be due to hospital staffing, limited access to specialists and procedures done outside of regular hours. More research needs to be done on why the rates are different so that stroke victims can have the best possible chance of surviving.

The researchers stress that quality of stroke care, imaging brain scans, times of admissions were not different between weekend hospitalizations and those that occurred during weekdays.

“Association between weekend hospital presentation and stroke fatality”
Jiming Fang, PhD, Gustavo Saposnik, MD, Frank L. Silver, MD, Moira K. Kapral, MD
doi: 10.1212/WNL.0b013e3181fb84bc
Neurology November 1, 2010 vol. 75 no. 18 1589-1596

Written by Christian Nordqvist