Thrombolysis for stroke ‘more likely at weekends’
MedWire News: Patients with acute ischemic stroke admitted to hospital on weekends are treated more aggressively than those admitted on weekdays, new research reveals.
Mortality rates did not differ between weekend and weekday admissions, however, and the study authors say that more research is needed to understand the differences in weekend and weekday care.
A team led by Abby Kazley (Medical University of South Carolina, Charleston, USA) conducted a retrospective study of patients admitted to hospitals in the state of Virginia between January 1998 and June 2006.
During the study period a total of 78,657 patients were hospitalized with acute ischemic stroke, 20,279 (25.8%) of whom were admitted on a Saturday or Sunday.
Tissue plasminogen activator (tPA) was used in 229 patients admitted on weekends and in 543 patients admitted on weekdays. In logistic regression analysis, weekend admission was a significant predictor of tPA use, at an odds ratio of 1.2. This figure was unchanged after adjustment for confounding factors. Other significant factors that predicted tPA use were patient age, gender, ethnicity, atrial fibrillation, hospital stroke volume, and stroke unit status.
Interestingly, mortality did not differ between patients admitted on weekends versus weekdays. Factors that predicted mortality included patient age, hospital size, patient proximity to hospital, tPA treatment, and atrial fibrillation.
Commenting on their results, Kazley et al note that, because tPA must be given within 3 hours from the onset of stroke symptoms, “aggressive identification and treatment regardless of the day of the week are essential for successful outcomes.”
If a patient experiences a stroke on a Saturday or Sunday, waiting until Monday for aggressive treatment is “not an option,” they remark.
The present study suggests that hospital stroke care on weekends “is not necessarily inferior to care provided on weekdays,” they write, and indeed “certain aspects of care such as aggressiveness may be improved.”
They conclude: “Further study on care variations that may improve patient outcomes is needed.”
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By Joanna Lyford