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Stroke Patients More Likely to Die If Hospitalized on a Weekend

People admitted to the hospital on a weekend after a stroke are more likely to die compared with people admitted on a weekday, regardless of the severity of the stroke they experience, concludes a study supported by the Canadian Stroke Network, part of Canada’s Networks of Centres of Excellence program.

“We wanted to test whether the severity of strokes on weekends compared with weekdays would account for lower survival rates on the weekends,” said Dr. Moira K. Kapral, of the University of Toronto. Dr. Kapral was part of the research team with the Institute for Clinical Evaluative Sciences in Ontario when the research was done and is currently co-principal investigator of the Registry of the Canadian Stroke Network. “Our results suggest that stroke severity is not necessarily the reason for this discrepancy.”

For the study, researchers analyzed five years of Canadian Stroke Network data on 20,657 patients with acute stroke from 11 stroke centres in Ontario. Only the first stroke a person experienced was included in the study.

The study found that people with moderate to severe stroke were just as likely to be admitted to the hospital on weekends and weekdays, but those with mild stroke were less likely to be admitted on weekends. Those who were seen on weekends were slightly older, more likely to be taken by ambulance and, on average, experienced a shorter time from the onset of stroke symptoms to hospital arrival. On the other hand, patients with mild stroke tended to delay going to hospital until after the weekend.

“We discovered that patients seen on weekends were more likely to receive thrombolysis, the use of clot-busting medications, and underwent neuroimaging more quickly than those seen on weekdays,” explains Dr. Karpal. “This suggests that hospitals do a very good job regardless of the day of the week managing thrombolysis, which is one of the most important aspects of acute stroke delivery.” Ontario has a well-developed regional stroke care system that coordinates thrombolysis delivery across the province and this may be part of the reason for this finding.

The study found that seven days after a stroke, people seen on weekends had an 8.1 percent risk of dying compared with a 7.0 percent risk of dying for those seen on weekdays. The results stayed the same regardless of age, gender, stroke severity, other medical conditions and the use of blood clot-busting medications. Also, there were no differences found in the quality of stroke care, including brain scans and admission time, between weekends and weekdays.

Previous studies have found worse outcomes in patients admitted to hospital on weekends compared with weekdays.  What this study revealed is that part of the difference in outcome is related to stroke severity. Those who are admitted to hospitals on weekends are those with the most severe strokes; people with minor stroke on weekends don't come to hospital until after the weekend.  However, this does not account for all of the observed difference in mortality, which may be due to differences in care or resources.

 “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,” said Dr. Kapral. “More research needs to be done on why the rates are different so that stroke victims can have the best possible chance of surviving.”

Although the study found that many important treatments such as thrombolysis , brain scans and stroke unit care were provided as often on weekends as on weekdays, there were many aspects of weekend care that this study was unable to measure.  For example, on weekends, there may be delays in assessments of stroke patients by personnel such as speech language pathologists, who help determine whether or not it is safe for a patient to eat or drink, or physiotherapists, who help patients with mobilization and recovery after stroke.  Future research could focus on identifying specific aspects of care that may differ on weekends and weekdays.

Dr. Karpal points out that it's important that people not delay assessment for stroke because of this study. 

“The worst thing a patient could do is wait until Monday. There are many stroke treatments that need to be given immediately to be effective, and people are far more likely to have complications if they stay at home than if they go to the hospital.”

Dr. Karpal also emphasized that it is important for hospitals to review their weekend staffing and resources to ensure that optimal medical care can be provided on weekends and off hours.

The study was supported by the Canadian Stroke Network, a catalyst for valuable stroke research, and was published in the November 2, 2010, issue of Neurology®, the medical journal of the This link will take you to another Web site American Academy of Neurology.

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