Stroke care organization overcomes the deleterious 'weekend effect' on 1-month stroke mortality: a population-based study

• Published in: European journal of neurology Vol. 20; no. 8; pp. 1177 - 1183
• Main Authors: Béjot, Y., Aboa-Eboulé, C., Jacquin, A., Troisgros, O., Hervieu, M., Durier, J., Osseby, G.-V., Giroud, M.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.08.2013; John Wiley & Sons, Inc
• Subjects: Aged; Aged, 80 and over; Analysis of Variance; Brain Ischemia - complications; Brain Ischemia - mortality; Brain Ischemia - therapy; Community Networks - statistics & numerical data; Data Interpretation, Statistical; epidemiology of stroke; Female; France - epidemiology; Holidays; Humans; Intracranial Hemorrhages - complications; Intracranial Hemorrhages - mortality; Intracranial Hemorrhages - therapy; Ischemic Attack, Transient - mortality; Ischemic Attack, Transient - therapy; Male; Middle Aged; outcomes; Population; registry; Regression Analysis; stroke; Stroke - mortality; Stroke - therapy; stroke care; Treatment Outcome; weekend; France; registry; stroke care; outcomes; epidemiology of stroke; stroke; weekend
• ISSN: 1351-5101; 1468-1331
• DOI: 10.1111/ene.12154

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.