Comprehensive Stroke Center Designations Could Decrease “Weekend Effect”

A new study claims that stroke patients admitted on the weekend have higher death rates than those admitted on weekdays at many hospitals, but not at comprehensive stroke centers (CSCs).

Researchers at the at the University of Medicine and Dentistry New Jersey (UMDNJ; New Brunswick, USA) examined records of 134,441 stroke patients discharged from 88 private acute care hospitals in the state of New Jersey (USA) between 1997 and 2007. Among these, 23.4% were admitted to one of 12 CSCs, 51.5% to one of 43 primary stroke centers, and 25.1% to one of 33 non-stroke centers. The researchers determined out-of-hospital mortality rates up to one year after admission.

The results showed that 28% of all stroke patients were admitted on the weekend, and that these patients had a significantly higher death rate (17.2%) within 90 days, when compared to patients admitted on a weekday (16.5%). After adjusting for patient demographics and coexisting conditions, the weekend effect represented a 5% difference in overall death rates. The researchers also found that although patients admitted after 2006 were 10 times more likely to receive intravenous (IV) thrombolysis treatment using analogs of tissue plasminogen activator (tPA), the "weekend effect" was still evident for stroke patients admitted to primary stroke centers or non-stroke centers. The study was published in the September 2001 issue of Stroke.

“The 'weekend effect' suggests patients admitted or treated during weekend hours will receive different care, have worse outcomes, which could account for several thousand US deaths,” said lead author James McKinney, MD, an assistant professor of neurology at UMDNJ. “Prior studies of the weekend effect have looked at in-hospital death rates and death rates right after discharge, but we wanted to look at longer outcomes after admission. We also wanted to determine if New Jersey's unique stroke center designations impacted patient treatment and outcomes.”

TPA is a serine protease found on the endothelial cells that line the blood vessels, and is also manufactured using recombinant biotechnology techniques. As an enzyme, it catalyzes the conversion of plasminogen to plasmin, the major enzyme responsible for clot breakdown. Because it works on the clotting system, tPA is used in clinical medicine to treat only embolic or thrombotic stroke. Use is contraindicated in hemorrhagic stroke and head trauma.

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