MORE PATIENTS WITH STROKES DIE ON WEEKEND HOSPITAL ADMISSION

R. Webster Crowley MD et al. reports that there is expanding literature to show that certain patients admitted during the weekend have worse outcomes than similar patients admitted during the week. Although many clinicians have hypothesized the presence of this "weekend effect" with patients with intracerebral hemorrhage, there is a paucity of studies validating this conjecture.

The authors performed a retrospective cohort study of patients with intracerebral hemorrhage (International Classification of Diseases, 9th Revision, Clinical Modification=431) extracted from the 2004 Nationwide Inpatient Sample. Multivariable logistic regression analyses and Cox proportional hazards regression were conducted to calculate the odds of death (within 7, 14, and 30 days) and the hazard ratio of death for patients with weekend intracerebral hemorrhage admissions compared with weekday intracerebral hemorrhage admissions. All analyses were adjusted for concurrent differences in length of stay, patient demographics, and comorbid disease.

The authors found that weekend hospital admissions accounted for 26.8% of the 13 821 patients with a diagnosis of intracerebral hemorrhage in the National Inpatient Sample. Admission during the weekend was a statistically significant independent predictor of death within 7 days (OR, 1.14; 95% CI, 1.05 to 1.25), within 14 days (OR, 1.15; 95% CI, 1.05 to 1.25), and within 30 days (OR, 1.15; 95% CI, 1.05 to 1.25).

The adjusted hazard of in-hospital death (hazard ratio, 1.12; CI, 1.05 to 1.20) indicates that the overall risk of in-hospital death with intracerebral hemorrhage is 12% higher with weekend admission, leading the authors to conclude that weekend admission for intracerebral hemorrhage was associated with increased risk-adjusted mortality when compared with admission during the remainder of the week.

COMMENT.
Is this one more instance of poor turnover problems with housestaff and nurses. We’ve seen a lot of problems with turnovers of patients with increasing frequency of shifts between hospitalists and nurses especially during a weekend. We’ve seen this same higher mortality with heart attacks admitted on weekends too. This study needs the highest priority to “fix the system.”


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