Stroke care organization overcomes the deleterious 'weekend effect' on 1‐month stroke mortality: a population‐based study. Issue 8 (3rd April 2013)

• Record Type: Journal Article
• Authors: Béjot, Y.; Aboa‐Eboulé, C.; Jacquin, A.; Troisgros, O.; Hervieu, M.; Durier, J.; Osseby, G.‐V.; Giroud, M.
• Is Part Of: European journal of neurology. Volume 20:Issue 8(2013:Aug.)
• Page Start: 1177
• Page End: 1183
• Publication Date: 2013-04-03
• Subjects: Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/ene.12154
• Languages: English
• ISSNs: 1351-5101

Abstract

<abstract abstract-type="main" xml:lang="en" id="ene12154-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ene12154-sec-0001" sec-type="section"> <title>Background and purpose</title> <p>Suffering a stroke during the weekend is associated with a poorer prognosis. The impact of implementing a dedicated stroke care network in Dijon, France, in 2003 on 30‐day mortality in strokes/transient ischaemic attacks (TIA) occurring during weekends/bank holidays was evaluated.</p> </sec> <sec id="ene12154-sec-0002" sec-type="section"> <title>Methods</title> <p>All cases of stroke and TIA from 1985 to 2010 were identified from a population‐based registry, using multiple overlapping sources of information. Demographics and clinical data were recorded. Cox regression models were used to evaluate associations between day of onset (weekdays versus weekends/bank holidays) and 30‐day all‐cause mortality. Data were stratified according to time periods [before (1985–2003) and after (2004–2010) implementation of the stroke network] and stroke subtypes (ischaemic stroke and intracerebral hemorrhage).</p> </sec> <sec id="ene12154-sec-0003" sec-type="section"> <title>Results</title> <p>Of the 5864 recorded patients, 1465 (25%) had their event during weekends/bank holidays. Patients with stroke/TIA during weekdays were comparable with those with stroke/TIA during weekends/bank holidays for baseline characteristics. Excess mortality was observed in patients with stroke/TIA during weekends/bank holidays during 1985–2003 (18.2% vs. 14.0%, <italic>P</italic> < 0.01) but not during 2004–2010 (8.4% vs. 8.3%, <italic>P</italic> = 0.74). Onset during weekends/bank holidays was associated with a higher risk of 30‐day mortality during 1985–2003 (adjusted hazard ratio 1.26; 95% CI 1.06–1.51, <italic>P</italic> = 0.01), but not during 2004–2010 (adjusted hazard ratio 0.99; 95% CI 0.69–1.43, <italic>P</italic> = 0.97).</p> </sec> <sec id="ene12154-sec-0004" sec-type="section"> <title>Conclusion</title> <p>The deleterious effect of weekends/bank holidays on early stroke mortality disappeared after the organization of a dedicated stroke care network in our community. Our findings provide strong support for the implementation of quality improvement initiatives in order to attenuate inequalities in the management of stroke patients.</p> </sec> </abstract>