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Table of Contents
Vol. 20, No. 5, 2005
Issue release date: October 2005
Section title: Original Paper
Cerebrovasc Dis 2005;20:325–331
(DOI:10.1159/000087932)

The Effect of Weekends and Holidays on Stroke Outcome in Acute Stroke Units

Hasegawa Y. · Yoneda Y. · Okuda S. · Hamada R. · Toyota A. · Gotoh J. · Watanabe M. · Okada Y. · Ikeda K. · Ibayashi S.
Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Osaka, Japan

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: June 30, 2004
Accepted: June 20, 2005
Published online: November 01, 2005
Issue release date: October 2005

Number of Print Pages: 7
Number of Figures: 1
Number of Tables: 4

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED

Abstract

Background and Purpose: In almost all acute stroke units in Japan, staffing level is lower on weekends and holidays and rehabilitative services are provided only on weekdays. We sought to investigate the effects of low-volume care early after stroke resulting from weekends and holidays on the outcome of stroke. Methods: Patients with completed stroke within 72 h of onset were prospectively registered by 10 acute stroke units in Japan. Main outcome measures were favorable outcomes as indicated by a score of 0–1 on the modified Rankin scale (mRS01) on their 21st hospital day and at discharge and case fatality during the hospital stay. Cox proportional hazardsmodels were used to identify the effects of weekday admission and a weekday ratio (a number of weekdays / total length of hospital stay, or 21 days if hospitalization was longer than 21 days) on the main outcome measures. Results: In a total of 1,134 patients, Cox proportional hazards regression analyses demonstrated that the weekday admission was significantly associated with mRS01 at discharge (hazard ratio, HR: 1.385, 95% CI: 1.087–1.764) and case fatality (HR: 0.477, 95% CI: 0.285–0.798). In 858 patients with rehabilitative therapy, the weekday ratio was significantly associated with mRS01 at discharge (p = 0.014). Compared with the lowest tertile of weekday ratio (<66.6%), the highest tertile (>71.4%) was significantly positively associated with mRS01 at discharge (HR: 1.524, 95% CI: 1.053–2.206; p < 0.026). Conclusions: Weekday admission was an independent negative predictor of case fatality and a positive predictor of favorable outcome (mRS01) at discharge from acute stroke units. In patients with rehabilitative therapy, a reduction in the weekday ratio was also associated with unfavorable outcome, probably due to a reduction in multidisciplinary care.

© 2005 S. Karger AG, Basel


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: June 30, 2004
Accepted: June 20, 2005
Published online: November 01, 2005
Issue release date: October 2005

Number of Print Pages: 7
Number of Figures: 1
Number of Tables: 4

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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