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Don't Have a Stroke on the Weekend

Study finds emergency treatment worse on Saturday and Sunday

En español | Your odds of surviving a stroke drop dramatically if you go to the hospital on the weekend, a new British study shows.

This deadly "weekend effect" means you are less likely to be treated with clot-busting drugs and more likely to face complications in the hospital and not be discharged to your home, according to the new study, published in the Archives of Neurology.

Ambulance staff and doctor transporting patient

Weekend stroke patients in the ER are more likely to face complications. — Photo by Chris Crisman/Corbis

The findings highlight the problems doctors here and abroad have found with hospital treatment on weekends versus weekdays, says William Palmer, an Imperial College London researcher who led a review of the records of nearly 94,000 men and women admitted to English hospitals between April 1, 2009, and March 31, 2010.

"People always knew there was a weekend issue," Palmer says, but the new study provides hard numbers: Weekend patients were only 83 percent as likely to receive brain scans within their first 24 hours in the hospital compared with those admitted during the weekdays, and just 82 percent as likely to receive clot-busting medical treatment.

Meanwhile, they were 11 percent more likely to suffer from aspiration pneumonia — a common post-stroke condition caused by paralyzed throat muscles — and 18 percent more likely to die within their first seven days in the hospital. Palmer's team calculated that among all English stroke patients, 350 in-hospital deaths could be avoided each year if weekend care matched levels provided during the weekdays.

A study of New Jersey hospitals published last year in the U.S. journal Stroke reported similar results, says lead researcher James McKinney, M.D., an assistant professor of neurology at the Robert Wood Johnson Medical School of the University of Medicine and Dentistry of New Jersey.

"There is a 5 percent higher chance of dying [within] 90 days" for patients with a stroke admitted to hospitals on weekends, McKinney says, adding that hospitals often are understaffed after hours and on the weekends, with potentially seriously negative consequences for patients. Technicians trained to perform brain scans, for instance, might be unavailable, even though patients suspected of having had a stroke ideally should undergo a scan within 25 minutes of arrival at the hospital.

Still, McKinney's study found a ray of light: Patients brought to comprehensive stroke centers, which typically have neurosurgeons and stroke neurologists on-call, did just as well on the weekends as during the weekdays.

For individuals, "the most important thing is to be able to recognize whether you or someone close to you is having a stroke," McKinney says. The acronym FAST helps in recognizing the warning signs and need for speed: facial droop, arm weakness, speech slurred and time since symptoms began.

For patients who may be suffering a stroke, a brain scan needs to be performed quickly so doctors know whether to administer clot-dissolving drugs, McKinney says. The drugs are only effective if taken within a limited amount of time.

For these reasons, patients or family members need to "ask about what treatments are available to treat stroke symptoms."

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