Stroke patients who are admitted to hospital during weekends tend to have worst outcomes and are less likely to receive proper emergency treatment compared to those admitted during a weekday, researchers from Imperial College, London, England, reported in Archives of Neurology. The authors added that prior studies from several different countries had identified higher mortality rates in patients admitted to hospital at weekends for various different medical conditions.
There is even a term for the apparent difference in a patient’s chances of receiving full care during weekends; it is called the weekend effect.
Lead author, William L. Palmer, MA, MSc, and team wrote that the weekend effect challenges the statement made by many regarding the equality of care patients receive when being hospitalized, irrespective of when this occurs.
Some studies have looked at how stroke patients might be affected, depending on whether they are admitted to hospital during a weekday or weekend – a number of them have suggested that weekend patients are less likely to eventually go back home, they have a higher risk of death, and poorer access to treatments. Put simply – previous studies have suggested weekend stroke patients have poorer outcomes. The authors added, though, that those studies had not identified a clear and compelling link between admission-to-hospital day and mortality rates due to stroke.
Palmer and team set out to find out whether a stroke patient’s access to the hospital’s best and safest stroke care varies depending on whether he/she was admitted on a weekday or weekend.
They carried out a retrospective cohort study of 93,621 patients, in England, who had been hospitalized with stroke from 1st April, 2009 to the end of March, 2010. The team gathered data on which day patients were hospitalized and compared six indicators of stroke care, including hospital discharge, 30-day readmission rates, availability of brain scans, availability of clot treatments (thrombolysis), seven-day mortality, and complications.
Of these 93,621 stroke patients, irrespective of day of admittance to hospital:
- 9.3% (8,722) died in hospital within seven days of being admitted.
- 17.1% (16,013) died within 30 days
- 46% had a brain scan on the day they were hospitalized
- 2.6% received thrombolysis on the day they were hospitalized
- 5.2% had aspiration pneumonia
- 72.6% were discharged from hospital and allowed to go home
- 11% were back in hospital within 30 days of being discharged
24.9% (23,297) of the stroke patients were hospitalized on weekends. Fewer patients were admitted to hospital during weekends compared to weekdays (15.6% on Mondays,12.4% on Sundays).
Below are the differences, between a weekday and weekend admittance, identified in the six measures of quality and safety for stroke patients:
- Same day brain scan
– weekday admittance – 47.8%
– weekend admittance – 42.6% - Thrombolysis
– weekday admittance – 2.7%
– weekend admittance – 2.2% - Aspiration pneumonia
– weekday admittance – 5.1%
– weekend admittance – 5.6% - 7-day hospital mortality
– weekday admittance – 9%
– weekend admittance – 10.3% - Discharge to usual place of residence
– weekday admittance – 72.9%
– weekend admittance – 71.3% - Readmitted to hospital within 30 days of discharge
– weekday admittance – 11%
– weekend admittance – 11%
The authors believe that weekend figures are poorer because of a lack of staff, especially specialized staff, as well as poorer access to urgent treatment. They emphasized that better management of existing resources, and possibly some additional investment would, in most cases, address this difference between weekday and weekend outcomes.
In an Abstract in the same journal, the authors concluded that compared to those admitted on a weekday, stroke patients hospitalized on a Saturday or Sunday:
- Have a smaller chance of receiving urgent treatments
- Have worse outcomes across most indicators
- Are more likely to die within seven days of being admitted
They added that even though adjustments had been made for case mix, they could not rule out some of the effects being due to unmeasured differences between weekday and weekend patients.
The researchers suggest that across England, 350 avoidable in-hospital deaths due to stroke are occurring each year, and 650 more people could be discharged to their homes within 56 days if weekday performances were replicated on weekends.
Approximately 795,000 Americans have a stroke each year in the USA, of whom 610,000 are new strokes (first strokes). Of the 795,000, about 185,000 go on to have another stroke.
Every 40 seconds somebody in the USA has a stroke, and every four minutes somebody dies of stroke.
87% of all strokes in the USA are ischemic strokes – when blood clots block the blood vessels to the brain.
The total cost of stroke in the USA in 2010, including total cost of health care services, drugs, and days off work, reached $53.9 billion.
Stroke is the number one cause of serious long-term disability in America.
When referring to the USA, Palmer said:
“The results are consistent with previous studies in the U.S., which have suggested a weekend effect in stroke care. However, to date, there has not been such a comprehensive study in the U.S.”
A stroke occurs when there is a blood clot or ruptured artery, or a blood vessel does not provide adequate blood supply to an area of the brain. If brain cells do not get their vital supply of glucose and oxygen, they start to die and brain damage occurs, often resulting in impairment of memory, speech and/or movement.
There are two main types of stroke:
- Ischemic stroke – there is a blood clot (thrombus) in a blood vessels that blocks the flow of blood to a part of the brain. Sometimes, the blood clot can form elsewhere in the body, breaks off and becomes free floating (embolus), and eventually makes its way through the bloodstream to the brain.
- Hemorrhagic stroke – may have two possible causes: 1. A blood vessel on the surface of the brain ruptures and fills the space between the brain and the skull with blood (subarachnoid hemorrhage). 2. A weak artery in the brain ruptures and fills the surrounding tissue with blood (cerebral hemorrhage).
In both cases, the brain does not receive enough blood, plus the accumulation of leaked blood places too much pressure on the brain.
Written by Christian Nordqvist