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An increased mortality rate among patients admitted to hospital at weekends has been found in many studies, and this ‘weekend effect’ has been used to justify major health service reorganisation. Most studies have used routine administrative data to adjust for potential confounding factors, and are unable to measure differences in illness severity due to the tendency of patients with milder symptoms to stay home at weekends. We set out to estimate the importance of such unmeasured ‘confounding by severity’, using data from a hospital stroke register.

Do studies of the weekend effect really allow for differences in illness severity? An analysis of 14 years of stroke admissions