Malik M Adil1, Gabriel Vidal2, Lauren A Beslow2. 1. From the Department of Neurology, Ochsner Neuroscience Institute, Ochsner Clinic Foundation, New Orleans, LA (M.M.A., G.V.); and Departments of Pediatrics and Neurology, Yale University School of Medicine, New Haven, CT (L.A.B.). malikmuhammad.adil@gmail.com. 2. From the Department of Neurology, Ochsner Neuroscience Institute, Ochsner Clinic Foundation, New Orleans, LA (M.M.A., G.V.); and Departments of Pediatrics and Neurology, Yale University School of Medicine, New Haven, CT (L.A.B.).
Abstract
BACKGROUND AND PURPOSE: Studies have demonstrated differences in clinical outcomes in adult patients with stroke admitted on weekdays versus weekends. The study's objective was to determine whether a weekend impacts clinical outcomes in children with ischemic stroke and hemorrhagic stroke. METHODS: Children aged 1 to 18 years admitted to US hospitals from 2002 to 2011 with a primary discharge diagnosis of ischemic stroke or hemorrhagic stroke were identified by International Classification of Disease, 9th Revision, codes. Logistic regression estimated odds ratios and 95% confidence intervals for in-hospital mortality and discharge to a nursing facility among children admitted on weekends (Saturday and Sunday) versus weekdays (Monday to Friday), adjusting for potential confounders. RESULTS: Of 8467 children with ischemic stroke, 28% were admitted on a weekend. Although children admitted on weekends did not have a higher in-hospital mortality rate than those admitted on weekdays (4.1% versus 3.3%; P=0.4), children admitted on weekends had a higher rate of discharge to a nursing facility (25.5% versus 18.6%; P=0.003). After adjusting for age, sex, and confounders, the odds of discharge to a nursing facility remained increased among children admitted on weekends (odds ratio, 1.5; 95% confidence interval, 1.1-1.9; P=0.006). Of 10 919 children with hemorrhagic stroke, 25.3% were admitted on a weekend. Children admitted on weekends had a higher rate of in-hospital mortality (12% versus 8%; P=0.006). After adjusting for age, sex, and confounders, the odds of in-hospital mortality remained higher among children admitted on weekends (odds ratio, 1.4; 95% confidence interval, 1.1-1.9; P=0.04). CONCLUSIONS: There seems to be a weekend effect for children with ischemic and hemorrhagic strokes. Quality improvement initiatives should examine this phenomenon prospectively.
BACKGROUND AND PURPOSE: Studies have demonstrated differences in clinical outcomes in adult patients with stroke admitted on weekdays versus weekends. The study's objective was to determine whether a weekend impacts clinical outcomes in children with ischemic stroke and hemorrhagic stroke. METHODS:Children aged 1 to 18 years admitted to US hospitals from 2002 to 2011 with a primary discharge diagnosis of ischemic stroke or hemorrhagic stroke were identified by International Classification of Disease, 9th Revision, codes. Logistic regression estimated odds ratios and 95% confidence intervals for in-hospital mortality and discharge to a nursing facility among children admitted on weekends (Saturday and Sunday) versus weekdays (Monday to Friday), adjusting for potential confounders. RESULTS: Of 8467 children with ischemic stroke, 28% were admitted on a weekend. Although children admitted on weekends did not have a higher in-hospital mortality rate than those admitted on weekdays (4.1% versus 3.3%; P=0.4), children admitted on weekends had a higher rate of discharge to a nursing facility (25.5% versus 18.6%; P=0.003). After adjusting for age, sex, and confounders, the odds of discharge to a nursing facility remained increased among children admitted on weekends (odds ratio, 1.5; 95% confidence interval, 1.1-1.9; P=0.006). Of 10 919 children with hemorrhagic stroke, 25.3% were admitted on a weekend. Children admitted on weekends had a higher rate of in-hospital mortality (12% versus 8%; P=0.006). After adjusting for age, sex, and confounders, the odds of in-hospital mortality remained higher among children admitted on weekends (odds ratio, 1.4; 95% confidence interval, 1.1-1.9; P=0.04). CONCLUSIONS: There seems to be a weekend effect for children with ischemic and hemorrhagic strokes. Quality improvement initiatives should examine this phenomenon prospectively.