Specialized Stroke Centers Deliver on the Weekends
THURSDAY Aug. 25, 2011 -- At many hospitals, stroke patients face higher odds of dying if they're admitted over the weekend rather than a weekday, but a new study finds equally good results for patients treated at comprehensive stroke centers.
New Jersey researchers found that the so-called "weekend effect" -- an increased risk of death associated with Saturday and Sunday admissions -- evaporated for stroke patients treated at state-certified comprehensive stroke centers.
"Not all hospitals are created equal," said lead researcher Dr. James McKinney, an assistant professor of neurology at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School in New Brunswick. "Centers that specialize in [complex] stroke are going to have better outcomes," he said.
In these specialized centers, there was no difference in deaths among patients admitted over the weekend or during the week, McKinney said.
For the study, published in the Aug. 25 online edition of Stroke, McKinney's team looked at the medical records of more than 134,000 stroke patients seen at 88 acute care private hospitals between 1997 and 2007. These hospitals included 12 comprehensive stroke centers, 43 primary stroke centers and 33 non-stroke hospitals. The researchers limited their analysis to patients treated for their first ischemic stroke (a stroke caused by a blockage in blood to the brain).
Hospitals certified by the state of New Jersey as comprehensive or primary stroke centers are designed to provide emergency care to patients with acute stroke symptoms, but only comprehensive stroke centers are equipped to offer specialized care for complex strokes.
"Comprehensive stroke centers have 24/7 neurosurgical coverage, 24/7 neuroradiology coverage and are involved in advanced stroke treatment and in clinical research," McKinney said.
Overall, the researchers found that the death rate 90 days after patients were treated for stroke over the weekend was 17.2 percent, compared with 16.5 percent for weekday admissions. But after adjusting for factors such as other medical conditions, the "weekend effect" raised the death rate to a 5 percent difference between the two groups.
This problem appeared to be largely due to a decrease in hospital staff and critical services on the weekend, McKinney said. "Fewer technicians are there, attending physicians may pop in and pop out, so a lot of hospitals are running on a kind of skeleton crew on the weekend, compared with weekdays," he said.
But no increase in 90-day mortality linked to weekend visits was seen in patients treated at the comprehensive stroke centers.
Dr. Gregg Fonarow, chairman of the American Heart Association's Hospital Accreditation Science Committee and professor of cardiovascular medicine of the University of California, Los Angeles, said that "admission to the hospital during weekends is associated with increased mortality in many, but not all, acute medical conditions."
Heart attack, stroke, blood clot and intensive care unit admissions, among others, during weekends have all been linked with increased in-hospital or short-term mortality compared with weekdays, he said.
"Reduced staffing and physician coverage, decreased use of invasive therapies, and differences in patient characteristics may, in part, explain the discrepancy in outcomes between weekend and weekday hospital admissions," Fonarow said.
Greater hospital staffing for critical services, specialty stroke services and hospital participation in systems of care, such as the American Stroke Association's "Get With the Guidelines - Stroke Program, "may help to ameliorate the weekend effect and be lifesaving," he added.
Another stroke expert, Dr. Ralph Sacco, president of the American Heart Association/American Stroke Association, said that "the study adds to the increasing evidence of improved outcomes for patients treated at stroke centers."
"We have been advocating for more stroke centers," said Sacco, who is also chairman of the department of neurology at the University of Miami Miller School of Medicine.
"The public should know where the closest stroke center is, so they can get urgent attention," he said.
For more on stroke, visit the American Stroke Association.
Posted: August 2011
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