Hospital care for patients experiencing weekend vs weekday stroke: a comparison of quality and aggressiveness of care

Arch Neurol. 2010 Jan;67(1):39-44. doi: 10.1001/archneurol.2009.286.


Background: We examined the quality and aggressiveness of care for the treatment of acute ischemic stroke (AIS) on weekends vs weekdays. Acute ischemic stroke is a leading cause of death and disability in the United States, and aggressive treatment must be provided within 3 hours for optimal patient outcomes. Because of this short treatment window for the administration of tissue plasminogen activator, patients need around-the-clock access to high-quality and aggressive care.

Objective: To determine whether there is a difference in the quality or aggressiveness of care for patients experiencing AIS on weekends vs weekdays.

Design: Retrospective study.

Setting: Academic research. Patients We conducted a retrospective study of patients with AIS in Virginia. Two logistic regression analyses assessed the relationship between weekend admission and quality and aggressiveness of care, while controlling for appropriate patient-level and hospital-level control variables. A propensity score stratification approach controlled for selection bias.

Main outcome measures: Treatment with tissue plasminogen activator and in-hospital mortality.

Results: Patients with AIS admitted on weekends are more likely to receive tissue plasminogen activator than those admitted on weekdays (P < .05). No statistically significant difference was noted in patient mortality based on day of admission (P >or= .05). We detected no difference in the likelihood to seek hospital care on weekends between patients with AIS vs patients with hemorrhagic stroke.

Conclusions: Patients experiencing AIS are more likely to receive tissue plasminogen activator on weekends than on weekdays. Patients experiencing AIS who are admitted on weekends are no more likely to die than those who are admitted on weekdays. Further research is necessary to understand differences in weekend vs weekday care.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Cause of Death
  • Emergency Medical Services / standards
  • Emergency Medical Services / statistics & numerical data
  • Emergency Medical Services / trends*
  • Female
  • Fibrinolytic Agents / therapeutic use
  • Health Services Accessibility / standards
  • Health Services Accessibility / statistics & numerical data
  • Health Services Accessibility / trends
  • Hospital Mortality / trends*
  • Hospitalization / statistics & numerical data
  • Hospitalization / trends*
  • Humans
  • Hypoxia-Ischemia, Brain / mortality
  • Hypoxia-Ischemia, Brain / therapy*
  • Length of Stay
  • Male
  • Outcome Assessment, Health Care / methods
  • Personnel Staffing and Scheduling / standards
  • Personnel Staffing and Scheduling / statistics & numerical data
  • Personnel Staffing and Scheduling / trends
  • Propensity Score
  • Quality of Health Care / standards
  • Quality of Health Care / statistics & numerical data
  • Quality of Health Care / trends*
  • Retrospective Studies
  • Risk Factors
  • Stroke / mortality
  • Stroke / therapy*
  • Survival Rate
  • Time Factors
  • Tissue Plasminogen Activator / therapeutic use
  • United States / epidemiology
  • Virginia / epidemiology


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator