Comprehensive Stroke Centers

See related article, pages 2403–2409.A growing body of literature has highlighted a significant discrepancy in outcomes for patients admitted on weekends versus weekdays for a number of diseases such as acute myocardial infarction,1 congestive heart failure,2 gastrointestinal hemorrhage,3 pulmonary embolism,4 and intracerebral hemorrhage.5 For acute ischemic stroke, the results have been variable with some studies demonstrating a significant difference in outcomes for patients admitted on weekends compared with weekdays6,7 whereas others,8 including a recent study using the Nationwide Inpatient Sample Database,9 failed to demonstrate a difference. Up to this point, much of this work has focused on early or in-hospital mortality and there is a paucity of data concerning longer-term outcomes examining a potential weekend effect. Additionally, previous work has noted that this weekend effect may have diminished over time10; this observation has been ascribed to a potential improvement in stroke care over time. Finally, there have been some data demonstrating that patients admitted to comprehensive stroke centers on the weekends have similar outcomes compared with weekday admissions.11In the present study, McKinney and colleagues have provided an additional contribution attempting to examine disparities in stroke care dependent on the time of the week admitted. Furthermore, they sought to examine if this potential difference has been mitigated over time through modifications in the organization and delivery of stroke care. The authors have used a database that has several inherent advantages well suited to the aims of their study. They used the Myocardial Infarction Data Acquisition System (MIDAS) administrative database containing demographic and clinical data on patients discharged with a primary diagnosis of cerebral infarction from all nonfederal acute care hospitals in New Jersey. The authors obtained data on out-of-hospital deaths by matching MIDAS records with …