Abstract
A
“weekend effect” resulting in higher mortality rates for patients with
stroke admitted on weekends has been reported. We examine this
phenomenon for patients with acute ischemic stroke (AIS) presenting to
telestroke (TS) sites to determine its effect on stroke alert process
times and outcomes. From October 2015 to June 2017, we reviewed patients
with AIS receiving intravenous alteplase within our TS network. We
compared patients presenting to TS sites on weekdays (Monday 07:00 to
Friday 18:59) to those presenting on weekends (Friday 19:00 to Monday
06:59). We analyzed door-to-alert activation, alert activation-to-TS
evaluation, door-to-imaging, and door-to-needle times. Rates of
favorable outcome (modified Rankin Scale score ≤2) and death at 90 days
were compared. We identified 89 (54 weekday and 35 weekend) patients
(mean age: 71.8 ± 13.3 years, 47.2% women) during the study period.
Median door-to-alert activation (P = .01) and door-to-needle (P
= .004) times were significantly longer for patients presenting on
weekends compared to weekdays. There were no significant differences in
median door-to-imaging (P = .1) and alert activation-to-TS evaluation (P = .07) times. Rates of favorable outcome (P = .19) and death (P
= .56) at 90 days did not differ. While there were no significant
differences in outcomes, patients presenting on weekends had longer
door-to-alert activation and door-to-needle times. Efforts to improve
methods in efficiency of care on weekends should be considered.
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