Weekend Effect in Children With Stroke in the Nationwide Inpatient Sample
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.
- hospital mortality
- International Classification of Diseases
- intracranial hemorrhages
- Received March 13, 2016.
- Revision received March 17, 2016.
- Accepted March 18, 2016.
- © 2016 American Heart Association, Inc.