Stroke Code Patients Are More Likely To Arrive at the Hospital by Ambulance on Weekends vs. Weekdays (P07.018)

Abstract

Objective: To assess the arrival mode of acute ischemic stroke (AIS) patients on weekends compared with weekdays. Background Conflicting data exist on whether there is a weekend vs. weekday effect on AIS care processes and outcomes, but these associations may be affected by several pre-hospital factors including mode of hospital arrival. We assessed the arrival mode of stroke code patients to the hospital on weekends vs. weekdays. Design/Methods: We analyzed the dataset of an AIS network comprising prospectively collected socio-demographic, clinical, discharge and day-90 data on AIS patients presenting within 12 hours of ictus to five hospitals in San Diego between June 2004 and May 2011. Weekend admission was defined as the period from Friday, 17:01, to Monday, 08:59. The main outcome of interest was mode of arrival (ambulance vs. other). Outcomes were adjusted for pre-specified covariates in a multivariable logistic regression model. Pre-specified interactions of arrival mode vs. sex, race-ethnicity, and stroke severity were also evaluated. Results: Of 1238 patients, the mean age was 70 years, with 47% female, 66% Non-Hispanic White, 15% Hispanic White, 11% Black, and 8% other ethnicity. Baseline characteristics were similar in weekend and weekday patients. Patients presenting on weekends vs. weekdays were more likely to arrive at the hospital by ambulance (82.3 vs. 76.8%, p=0.017) and this difference persisted in multivariable analyses (adjusted OR 1.49, 95% CI: 1.10-2.01, p=0.009), but there were no interactions with sex (p=0.67), ethnicity (p=0.66), or index stroke severity (0.65). Conclusions: Stroke code patients in San Diego were more likely to arrive to the hospital by ambulance on weekends compared to weekdays. Further studies will need to investigate the reasons for this arrival mode disparity and its impact on care and outcomes. More community education is warranted to promote calling the ambulance for stroke-like symptoms, especially on weekdays. Supported by: Funding: NIH 5P50NS044148 (Meyer BC). Disclosure: Dr. Schlick has nothing to disclose. Dr. Raman has nothing to disclose. Dr. Hemmen has nothing to disclose. Dr. Meyer has received personal compensation for activities with the National Institues of Health and a community hospital. Dr. Meyer has nothing to disclose. Dr. Ernstrom has nothing to disclose. Dr. Ovbiagele has received personal compensation for activities with Avanir Pharmaceuticals.