Comprehensive Stroke Centers Overcome the Weekend Versus Weekday Gap in Stroke Treatment and Mortality
Comprehensive Stroke Centers Overcome the Weekend Versus Weekday Gap in Stroke Treatment and Mortality
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DOI：
10.1161/strokeaha.110.612317
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发表时间：
2011-09-01
期刊：
影响因子：
8.3
通讯作者：
Kostis, John B.
中科院分区：
文献类型：
--
作者：
McKinney, James S.;Deng, Yingzi;Kostis, John B.
背景和目的-医院人员在周末可能会减少。先前对周末卒中护理差异的研究主要集中在住院死亡率上，结果不一。我们假设周末住院的中风患者的90天死亡率高于工作日，随着时间的推移，这种差异随着中风护理组织和交付的改进而最小化。方法：我们使用心肌梗死数据采集系统管理数据库，该数据库包括1996年至2007年间新泽西州所有非联邦急症护理医院以原发性脑梗死出院患者的数据。通过将MIDAS记录与新泽西州死亡登记文件相匹配来评估院外死亡。新泽西州的医院被国家指定为综合中风中心、初级中风中心或非中风中心。主要结局指标为入院后90天全因死亡率。结果：在研究期间，共收治了13441例初步诊断为脑梗死的患者。共有23.4%的患者被送往综合卒中中心，51.5%的患者被送往初级卒中中心，25.1%的患者被送往非卒中中心。周末入院的中风患者90天死亡率高于工作日（17.2%比16.5%;P = 0.002）。周末入院90天校正后死亡风险显著高于周末入院（风险比1.05;95% CI 1.02 ~ 1.09）。周末与工作日入住综合卒中中心的患者90天死亡率无差异（风险比，1.01;95% CI, 0.95 ~ 1.08）。结论：周末入住新泽西医院的中风患者在90天内死亡的风险明显更高。在综合卒中中心没有观察到这样的死亡率差异。(中风。2011;42:2403 - 2409)。
Background and Purpose-Hospital staffing may be reduced on weekends. Prior studies of weekend disparities in stroke care have focused on in-hospital mortality with variable results. We hypothesized that 90-day mortality was higher in patients with stroke hospitalized on weekends versus weekdays, and this difference has been minimized over time by improvements in organization and delivery of stroke care.Methods-We used the Myocardial Infarction Data Acquisition System administrative database, which includes data on patients discharged with a primary diagnosis of cerebral infarction from all nonfederal acute care hospitals in New Jersey between 1996 and 2007. Out-of-hospital deaths were assessed by matching MIDAS records with New Jersey death registration files. New Jersey hospitals are designated by the state as comprehensive stroke centers, primary stroke centers, or nonstroke centers. The primary outcome measure was 90-day all-cause mortality after hospital admission.Results-A total of 134 441 patients were admitted with a primary diagnosis of cerebral infarction during the study period. A total of 23.4% were admitted to a comprehensive stroke center, 51.5% to a primary stroke center, and 25.1% to a nonstroke center. Ninety-day mortality was greater in patients with stroke admitted on weekends compared with weekdays (17.2% versus 16.5%; P = 0.002). The adjusted risk of death at 90 days was significantly greater for weekend admission (hazard ratio, 1.05; 95% CI, 1.02 to 1.09). No difference in 90-day mortality was observed for patients admitted to comprehensive stroke centers on weekends versus weekdays (hazard ratio, 1.01; 95% CI, 0.95 to 1.08).Conclusions-Patients with stroke admitted on weekends to New Jersey hospitals had a significantly higher risk of death by 90 days. No such difference in mortality was observed at comprehensive stroke centers. (Stroke. 2011;42:2403-2409.)