Canadian researchers report that strokes treated on weekends are 14% more deadly than those treated on weekdays. "And while the study included only Canadians, the best guess is that the difference in outcome might be even worse in the United States," said lead author Dr. Gustavo Saposnik, assistant professor of medicine at the University of Toronto.
"We don't have information on what's going on in the United States," Saposnik said. "But here, we have universal health insurance with no copayment. With all the different plans in the United States, it might be a little worse."
The Study
Saposnik and his colleagues had information on almost 26,700 people admitted to 606 Canadian hospitals for ischemic stroke. Ischemic strokes occur when a clot blocks a brain artery. More than 80% of strokes are ischemic; the rest are hemorrhagic, occurring when an artery bursts.
About a quarter of those people came to the hospitals on Saturdays or Sundays. After adjusting for age, gender and other complicating factors, the researchers found that people admitted on a weekend had a 14% higher risk of dying within seven days than those who came in on weekdays. They were also less likely to survive and go home.
Implications
This weekend effect" was greater for people admitted to rural rather than urban hospitals, and if the physician in charge was a general practitioner rather than a specialist.
The reasons for the difference are not clear, Saposnik said. "There may be some differences in resources in different hospitals on weekends. We are doing another study trying to address the underlying mechanism for our findings."
Whatever the reason, the experts' advice to people who suspect someone may be having a stroke remains the same no matter what day of the week it is, no matter what time of day," Saposnik said.
"In a rural or an urban area, they should seek medical attention right away," he said. "Call 911 and get to the nearest emergency room."
Recommendations
Quick action is needed because, in a stroke, "time means brain." Faster treatment means fewer brain cells will die.
This rule was stressed by Dr. Larry B. Goldstein, professor of medicine and director of the stroke center at Duke University, and chairman of the American Heart Association's Stroke Council.
He offered the following suggestion for those who believe a loved one might be experiencing a stroke: "Don't put a person in a car. It could be something other than a stroke. Just call 911, and hopefully the system will make sure that the patient gets to the appropriate facility."
Suukee symptoms include abrupt difficulty in speaking or understanding, weakness or numbness of an arm or leg and unexpected difficulty walking.
Appropriate help should be available "24/7," Goldstein said. There is a national system for accrediting round-the-clock stroke centers, and states including New York, Florida and Massachusetts have their own accrediting mechanisms, he said.
"The difference in weekend admissions found in this study may be real, but the potential benefits of early treatment well outweigh the risk of waiting," Goldstein said.
