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• W1479920479 abstract "To the Editor: Acute cerebrovascular events have seasonal, weekly, and circadian patterns. Ischemic and hemorrhagic strokes are more likely to occur in the morning1,2 because of several triggers, such as arterial blood pressure, vascular tone, blood coagulation, and fibrinolysis. A weekly pattern for stroke onset, characterized by a Monday peak, has also been reported.3 Moreover, it has recently been shown that patients hospitalized for ischemic stroke on weekends had higher mortality than those admitted on weekdays.4 This retrospective study, based on the database of the region Emilia Romagna (RER) of Italy, was aimed to verify whether hospital admissions for ischemic stroke confirm the existence of a weekly pattern and show differences between weekdays and weekends. The analysis included all hospital admissions for ischemic stroke between January 1998 and December 2006 recorded in the RER database, which has been collecting discharge records of patients admitted to hospital since 1998. The discharge records contain each patient's name, sex, date of birth, date and department of hospital admission and discharge, and up to eight discharge diagnoses, based on the International Classification of Diseases, Ninth Revision, Clinical Modification. Only hospitals with acute care facilities were considered, including first-level (24 h/d, 7 d/wk availability of computed tomography (CT) scans and a neurologist on active duty) and second-level (24 h/d, 7 d/wk availability of CT scans and an internist on active duty, with the possibility of being referred to a neurologist at the nearest first-level center) hospitals. Quality control for accuracy of the stroke diagnosis was warranted to avoid false-positive diagnoses. A CT scan was always performed on arrival to differentiate between ischemic and hemorrhagic stroke, and a second scan was usually performed 48 to 72 hours later. A neurologist or an internist always determined the diagnosis based on clinical and instrumental data. Because the database did not provide clinical information on each case, such as stroke severity or infarct volume, the analysis was limited in terms of fatal (death during hospitalization) and nonfatal (patient discharged alive) outcomes. The times of admission were divided into seven 1-day intervals, and the events were analyzed based on their occurrence on a weekend (the period between midnight Friday to midnight Sunday) versus a weekday. The distribution of admissions was tested for uniformity in all groups using the chi-square (χ2) test of goodness of fit. Significance levels were assumed for P<.05. During this period, the RER database contained the records of 56,453 patients with ischemic stroke (mean age 75.9±11.9, 50.1% male, 85.3% nonfatal). Stroke admissions were most frequent on Monday (16.6%) and least frequent on Sunday (12.9%) (P<.001). This weekly distribution was confirmed for all groups (P<.001) (Table 1). There were 42,815 patients (75.8%) admitted on weekdays and 13,638 (24.2%) on weekends. The observed versus the expected distribution, characterized by a higher frequency of events on weekdays (42,815 vs 40,324) and a lower frequency on weekends (13,638 vs 16,129) was significantly different (χ2=282,68, P<.001). The relationship of the distributions was the same for nonfatal (weekdays: 36,669 vs 34,413; weekends: 11,509 vs 13,765; χ2=272,73, P<.001) and fatal (weekdays: 6,146 vs 5,911; weekends: 2,129 vs 2,364; χ2=16,72, P<.001) cases. A separate analysis including all major national holidays as weekends did not alter the results. Acute cerebrovascular disease is a concern for people aged 65 and older.5 According to the data from our database, the mean age±standard deviation of patients with stroke is 75.9±11.9, and with transient ischemic attack is 76.8±11.5.6 A first result from this study is the confirmation of a greater likelihood of onset of ischemic stroke on Monday, similar to that reported for acute myocardial infarction (AMI)7; several potential triggers (stress from commencing weekly activities, higher blood pressure levels, and unfavorable biochemical status) have been proposed.7–9 Recent reports from North American settings indicate a negative weekend effect characterized by higher mortality in patients admitted for ischemic stroke7 and AMI,10 maybe because of less availability of hospital services and urgent procedures during weekends. One possible hypothesis could be that cases with different levels of severity may refer to emergency departments during weekends,11 but no differences were found in the weekday–weekend distribution of fatal and nonfatal stroke admissions, at least in our region. Further studies aimed at the evaluation of the clinical risk score on arrival and the need for specific urgent procedures during weekdays or weekends are needed. Conflict of Interest: There are no financial, personal, or potential conflicts as they relate to the sponsoring agent, products, technology, or methodolgies involved in the letter submitted for publication for any author. Supported in part by research grant “Fondo Ateneo Ricerca—FAR,” University of Ferrara, Italy. Author Contribution: All contributed to the data gathering, analysis and writing of the paper. Sponsor's Role: None." @default.
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• W1479920479 date "2009-08-01" @default.
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• W1479920479 title "DAY-OF-WEEK DISTRIBUTION OF FATAL AND NONFATAL ISCHEMIC STROKE IN ELDERLY SUBJECTS" @default.
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• W1479920479 doi "https://doi.org/10.1111/j.1532-5415.2009.02375.x" @default.
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