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Weekend strokes may receive more aggressive treatment
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CHICAGO—Stroke
patients admitted to the hospital on the weekend appear more likely to
receive the clot-dissolving medication tissue plasminogen activator
than patients admitted during the week, according to a report in the
January issue of Archives of Neurology, one of the Journal of the
American Medical Association (JAMA)/Archives journals. However, stroke
death rates appear similar among weekend and weekday admissions.
“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,” the authors write as background
information in the article. Some investigators have speculated that a
combination of factors—including shortages in resources, expertise and
providers—lead to less aggressive and lower quality care on the
weekends vs. weekdays.
Because it is unexpected, potentially serious and requires emergency
care, stroke offers an opportunity to study rates of aggressive
treatment and death, the authors note. Tissue plasminogen activator has
been shown to decrease disability among patients experiencing an acute
ischemic stroke, which occurs when a blood clot or other substance
blocks blood flow to the brain. However, the drug must be administered
within three hours from the onset of symptoms.
Abby S. Kazley, Ph.D., and colleagues at MUSC studied rates of tissue
plasminogen activator administration, along with death rates, among
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.
Patients admitted on the weekends were 20 percent more likely to
receive tissue plasminogen activator, which was administered to 229
weekend patients and 543 weekday patients. No statistically significant
difference was observed in death rate between the two groups (3,993
patients admitted on weekdays died, compared with 1,420 admitted on
weekends).
The similarity in death rate indicates that patients who receive tissue
plasminogen activator are more likely to die in the hospital than those
who do not, the authors note. This may be because physicians tend to
use the medication to treat more severe strokes, or because factors
such as sex and race/ethnicity influence death risk more than the
receipt of tissue plasminogen activator.
The differences in the aggressiveness of care may be explained by
differences in access to equipment or clinicians, who might be busier
with other patient care responsibilities during the week, the authors
note. “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 write. “Reduced road traffic and job
obligations on weekends may contribute to the possibility that patients
with acute ischemic stroke arrive sooner at the hospital.”
Friday, Jan. 29, 2010
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