Stroke care organization overcomes the deleterious ‘weekend effect’ on 1-month stroke mortality: a population-based study
Article first published online: 3 APR 2013
© 2013 The Author(s) European Journal of Neurology © 2013 EFNS
European Journal of Neurology
Volume 20, Issue 8, pages 1177–1183, August 2013
How to Cite
Béjot, Y., Aboa-Eboulé, C., Jacquin, A., Troisgros, O., Hervieu, M., Durier, J., Osseby, G.-V. and Giroud, M. (2013), Stroke care organization overcomes the deleterious ‘weekend effect’ on 1-month stroke mortality: a population-based study. European Journal of Neurology, 20: 1177–1183. doi: 10.1111/ene.12154
- Issue published online: 5 JUL 2013
- Article first published online: 3 APR 2013
- Manuscript Accepted: 28 FEB 2013
- Manuscript Received: 8 JAN 2013
- French Institute for Public Health Surveillance (InVS)
- Journées Neurologiques de Langue Française
- Regional Council of Burgundy
- epidemiology of stroke;
- stroke care;
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.
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).
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).
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.