Stroke Treatment Variance Doesn’t Affect Mortality

Research reported in the Archives of Neurology (2010;67(1):39-44) found that stroke patients admitted to hospitals over the weekend are more likely than those who arrive on weekdays to receive the FDA-approved clot-busting therapy intravenous tissue plasminogen activator (tPA).

Abby S. Kazley, PhD, assistant professor of health policy administration, and colleagues at Medical University of South Carolina in Charleston studied nearly 80,000 stroke patients admitted to Virginia hospitals from 1998 to 2006. The researchers found that those arriving on weekends were 20% more likely to receive tPA treatment, which has been shown to reverse the effects of ischemic stroke if given within a time-sensitive window of therapeutic opportunity. However, there was no statistically significant difference in death rates between the two groups.

University of Colorado Denver hospitalist Ethan Cumbler, MD (see “Spotlight on Stroke,” The Hospitalist, December 2009, p. 1), says the outcome was counter-intuitive, given prior research documenting limits in weekend hospital care, although lack of competition from elective hospital procedures and reduced road traffic on weekends might have contributed to the result. Stroke treatment benefits from well-designed systems of care that are able to respond quickly to emergent strokes, "especially in Joint Commission-certified primary stroke centers, which are mandated to provide rapid evaluation and response 24 hours a day." Dr. Cumbler notes, however, that in both groups, stroke patients received the critical treatment only about 1% of the time.

"It’s hard to know what to make of this study," adds University of California at San Francisco neurohospitalist J. Andrew Josephson, MD. "We know we deliver different care on nights and weekends; in this case not better or worse—just different.”

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