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Published on: January 18, 2018
Weekend Effect in Children With Stroke in the Nationwide Inpatient Sample
Malik M Adil1, Gabriel Vidal2, Lauren A Beslow2
1From 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.
Insights
Weekend hospital admissions for children with stroke are linked to worse outcomes. Children with ischemic stroke admitted on weekends had higher nursing facility discharge rates, while those with hemorrhagic stroke faced increased in-hospital mortality.
Area of Science:
- Pediatric Neurology
- Public Health
- Healthcare Quality
Background:
- Previous studies indicate disparities in adult stroke patient outcomes based on admission day (weekday vs. weekend).
- The impact of weekend admissions on pediatric stroke outcomes remains less understood.
Purpose of the Study:
- To investigate whether weekend admission influences clinical outcomes in pediatric patients diagnosed with ischemic stroke or hemorrhagic stroke.
Main Methods:
- Retrospective analysis of US hospital data (2002-2011) for children (1-18 years) with stroke.
- International Classification of Disease, 9th Revision (ICD-9) codes identified stroke cases.
- Logistic regression analyzed in-hospital mortality and nursing facility discharge rates for weekend vs. weekday admissions, controlling for confounders.
Main Results:
- For ischemic stroke (8467 children), weekend admissions (28%) showed no increased mortality but higher nursing facility discharge rates (25.5% vs. 18.6%, OR 1.5).
- For hemorrhagic stroke (10,919 children), weekend admissions (25.3%) were associated with higher in-hospital mortality (12% vs. 8%, OR 1.4).
Conclusions:
- A notable weekend effect exists for pediatric ischemic and hemorrhagic strokes.
- Further prospective research and quality improvement initiatives are recommended to address this phenomenon.
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.
