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Stroke care organization overcomes the deleterious ‘weekend effect’ on 1‐month stroke mortality: a population‐based study
Author(s) -
Béjot Y.,
AboaEboulé C.,
Jacquin A.,
Troisgros O.,
Hervieu M.,
Durier J.,
Osseby G.V.,
Giroud M.
Publication year - 2013
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.12154
Subject(s) - medicine , stroke (engine) , hazard ratio , proportional hazards model , intracerebral hemorrhage , population , weekend effect , demographics , demography , emergency medicine , confidence interval , subarachnoid hemorrhage , mechanical engineering , environmental health , sociology , engineering
Background and purpose 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. Methods 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). Results 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%, P < 0.01) but not during 2004–2010 (8.4% vs. 8.3%, P = 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, P = 0.01), but not during 2004–2010 (adjusted hazard ratio 0.99; 95% CI 0.69–1.43, P = 0.97). Conclusion 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.