Stroke care organization overcomes the deleterious 'weekend effect' on 1-month stroke mortality: a population-based study.
Eur J Neurol
; 20(8): 1177-83, 2013 Aug.
Article
em En
| MEDLINE
| ID: mdl-23551852
ABSTRACT
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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Ataque Isquêmico Transitório
/
Redes Comunitárias
/
Acidente Vascular Cerebral
Tipo de estudo:
Diagnostic_studies
/
Prognostic_studies
Limite:
Aged
/
Aged80
/
Female
/
Humans
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Male
/
Middle aged
País/Região como assunto:
Europa
Idioma:
En
Ano de publicação:
2013
Tipo de documento:
Article