J Clin Neurol.  2012 Dec;8(4):265-270. 10.3988/jcn.2012.8.4.265.

Weekend Admission in Patients with Acute Ischemic Stroke Is Not Associated with Poor Functional Outcome than Weekday Admission

Affiliations
  • 1Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea. choyj@paik.ac.kr
  • 2Stroke Center, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
  • 3Department of Neurology, The Catholic University of Korea College of Medicine, Seoul St. Mary's Hospital, Seoul, Korea.
  • 4Department of Neurology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea.
  • 5Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 6Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 7Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea.
  • 8Department of Biostatistics, College of Medicine, Korea University, Seoul, Korea.

Abstract

BACKGROUND
AND PURPOSE: Stroke requires consistent care, but there is concern over the "weekend effect", whereby a weekend admission results in a poor outcome. Our aim was to determine the impact of weekend admission on clinical outcomes in patients with acute ischemic stroke in Korea.
METHODS
The outcomes of patients admitted on weekdays and weekends were compared by analyzing data from a prospective outcome registry enrolling 1247 consecutive patients with acute ischemic stroke admitted to four neurology training hospitals in South Korea between September 2004 and August 2005. The primary outcome was a poor functional outcome at 3 months, defined as modified Rankin Scale (mRS) of 3-6. Secondary outcomes were 3-month mortality, use of thrombolysis, complication rate, and length of hospitalization. Shift analysis was also performed to compare overall mRS distributions.
RESULTS
On weekends, 334 (26.8%) patients were admitted. Baseline characteristics were comparable between the weekday and weekend groups except for more history of heart disease and shorter admission time in weekend group. Univariate analysis revealed poor functional outcome at 3 months, 3-month mortality, complication rate, and length of hospitalization did not differ between the two groups. In addition, overall mRS distributions were comparable (p=0.865). After adjusting for baseline factors and stroke severity, weekend admission was not associated with poor functional outcome at 3 months (adjusted odds ratio, 1.05; 95% CI, 0.74-1.50). Furthermore, none of secondary endpoints differed between the two groups in multivariate analysis.
CONCLUSIONS
Weekend admission was not associated with poor functional outcome than weekday admission in patients with acute ischemic stroke in this study. The putative weekend effect should be explored further by considering a wider range of hospital settings and hemorrhagic stroke.

Keyword

weekend effect; weekend admission; ischemic stroke
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