Patients who have a stroke on the weekend treated more aggressively

Kathleen Blanchard's picture
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New research shows that patients who have a stroke on the weekend are treated more aggressively using an intervention for stroke that can prevent disability. Clot busting drugs, called TPA (tissue plasminogen activator) were more likely to be given to stroke patients taken to the emergency room on weekends compared to during the week when clinicians may simply be busy caring for other patients.

The study found that patients with stroke were twenty percent more likely to receive aggressive stroke treatment on the weekend in a comparison of weekday and weekend stroke treatment. Patients admitted on the weekend for stroke were not more likely to die, making outcomes the same. The study looked at 78,657 patients admitted to Virginia hospitals with acute ischemic strokes between 1998 and 2006. Of these, 20,279 were admitted on weekends and 58,378 during the week.

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The study authors also noted that patients who receive the clot busting tissue plasminogen activator are more likely to die in the hospital compared to those who do not receive aggressive stroke treatment with TPA. The findings could be related to the severity of stroke, or there may be differences in outcomes based on ethnicity and gender that influence death rates.

Information from the study also suggests that "Although hospitals operate around the clock every day of the year, there are inevitable staffing differences during shifts, and there may be differences in the availability of diagnostic modalities or treatment options for care." TPA to dissolve a blood clot from stroke must be given within three hours of onset of symptoms. "Because of this short treatment window for the administration of tissue plasminogen activator, patients need around-the-clock access to high-quality and aggressive care," the authors write.

The authors explain the difference in stroke treatment on weekends compared to during the week may be the result of several factors. "Elective surgical procedures on weekends are rare, and this may contribute to decreased traffic and waiting time for diagnostic equipment, and result in quicker and more efficient diagnosis and determination of treatment." They also say that patients who have strokes on weekends may be getting more aggressive treatment because they can get to the hospital sooner without so much traffic on the road. Lastly, it is possible that doctor’s are busier during with week, explaining why more aggressive treatment for stroke occurs on weekends.

Arch Neurol. 2010;67[1]:39-44

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