Weekend strokes have higher death rate

There's no good time to have a stroke, but new research suggests that being admitted to a hospital for one type of stroke on a weekend might be a particularly bad time to suffer the debilitating brain injury.

Previous research has shown a "weekend effect" for patients admitted to the hospital for heart attack, a blood clot in a lung, a ruptured abdominal artery, and strokes of all kinds. In the current study, Dr. Aaron S. Dumont of the University of Virginia School of Medicine in Charlottesville, and colleagues looked at the risk of death in the 30 days following admission for intracerebral hemorrhage, the cause for up to 15 percent of all strokes.

Such hemorrhagic strokes result from excessive bleeding into the brain; other strokes are caused by blood clots that block blood flow.

Dumont's group compared mortality rates among 13,821 patients (49 percent male) admitted to a hospital for intracerebral hemorrhage during 2004. Of these, just more than a quarter were Saturday or Sunday admissions, they report in the journal Stroke.

After accounting for patient differences in age, gender, income and medical insurance, and other medical conditions, as well as hospital characteristics such as admission volume, and location, plus population density of the surrounding area, the researchers found that patients with intracerebral hemorrhage admitted on Saturdays and Sundays were 12 percent more likely to die in the hospital than those admitted Monday through Friday.

About 33 percent of those admitted on the weekends died in the hospital, compared with 30 percent of those admitted during the week.

These findings add to a growing body of evidence of increased mortality due to the "weekend effect," a period when hospital staffing can be less than optimal, notes Dumont.

Contributing factors to this "weekend effect" may be weekend shifts of fewer physicians and nurses who may have relative lack of experience, or limited availability of interventional procedures more commonly performed on weekdays, Dumont and colleagues surmise.

Nonetheless, the investigators call for "a substantial amount of institutional interest" in auditing current hospital systems for the contributing factors to the "weekend effect."

SOURCE: Stroke, July 2009