In early 2008, researchers at the International Stroke conference unveiled two studies showing a “weekend effect” in stroke– ie, mortality from stroke was higher on the weekends (and at night) than weekdays. We explored this topic in the June 2008 ACP Hospitalist.
Now, a new Archives of Neurology study has found no difference in stroke death rates based on weekend/weekday arrival. What’s more, stroke patients admitted on weekends were more likely to get tPA. This flies in the face of one of the main theories about the weekend effect–namely, that stroke rates may be higher on weekends because there is often a shortage of staff and resources, which leads to less aggressive treatment.
The authors’ explanation for increased use of tPA on weekends is that, during the week, clinicians may be busier and equipment is more likely to be tied up; there are fewer elective surgeries on the weekend. Also, patients may arrive sooner after stroke onset on the weekends, since traffic is generally lighter and people aren’t occupied at work, they said. (I’m guessing the logic here is that if patients arrive sooner, it’s less of a dilemma for doctors to decide on whether they are risking using tPA outside the advised time 3 – 4.5 hour time window).
Perhaps we’ll hear more on this issue at the Stroke conference in late February.
*This blog post was originally published at ACP Hospitalist*