Stroke patients admitted to hospital on weekend have higher death risk

[sanctus]

TORONTO (CP) - When it comes to stroke, doctors have a saying: "Time is brain." In other words, the sooner a person gets treatment after the onset of symptoms, the less damage may be done to this all-important organ.

But a Canadian study has found that patients admitted to hospital for ischemic stroke on a weekend have a higher risk of dying than patients admitted during the week.

This "weekend effect" has been previously documented in other conditions, such as cancer and pulmonary embolism, but little was previously known about its impact on stroke death, said lead author Dr. Gustavo Saposnik, a neurologist at St. Michael's Hospital in Toronto.

"This is a large, population-based study across Canada including different facilities - rural/urban, teaching/non-teaching facilities and small/large community," said Saposnik of the paper published Thursday in Stroke: Journal of the American Heart Association.

To conduct the study, researchers analyzed all hospital admissions for ischemic stroke in Canada from April 2003 to March 2004. An ischemic stroke, the most common type of stroke, is caused by a clot that blocks blood flow in an artery either leading to or inside the brain.

Of 26,676 stroke patients treated in 606 hospitals, 24.8 per cent were admitted on Saturdays and Sundays. Patients admitted on the weekend were age 75 on average, while those admitted on weekdays had an average age of 74.

After adjusting for age, sex and other medical conditions, researchers found that patients admitted on Saturdays or Sundays had a 14 per cent higher risk of dying within seven days of admission compared to patients admitted Monday to Friday.

The weekend death effect was even greater when patients were admitted to a rural hospital compared with an urban hospital and when the physician in charge was a general practitioner rather than a specialist. The study didn't define what type of specialist.

"Although the 'weekend effect' affected patients admitted to both rural and urban hospitals and those treated by general practitioners and specialists, the effect may be larger in patients admitted to rural hospitals and when the most responsible physician is a general practitioner," Saposnik said in a release.

But he stressed that a person with signs of stroke - which include abrupt difficulty speaking or understanding, dizziness, weakness or numbness affecting an arm or leg, or difficulty walking - must get to the hospital quickly no matter what day it is.

"Time is brain, so the sooner the patient seeks medical attention, the higher the chance of better outcome, no matter the day, time or living area."

Researchers said disparities in resources, expertise and staffing levels on weekends compared with weekdays may explain the difference in death rates.

Dr. Larry Goldstein, chair of the Stroke Council of the American Heart Association, also emphasized the importance of seeking immediate treatment whenever a person experiences stroke symptoms.

"Although the differences in weekend admission found in this study may be real, the potential benefits of obtaining early treatment would well outweigh the risk of waiting," Goldstein said in the release.

Copyright © 2007 Canadian Press

 

[MikeyDB]

In 1997 while driving downtown I suffered a hemorrhagic stroke but was unaware of what had actually happened. I attributed the symptoms to a migraine headache and instead of going to hospital, continued on my way home.
I had been talking with a friend via telephone and when the pain returned with greater intensity accompanied with vomiting. I managed to push the redial button on my phone and tell my friend that I feared something was very wrong…

My friend came to my home to find me curled in a fetal position on the floor screaming in pain and clutching my head. He helped me to his car and took me to a local walk-in clinic where the attending nurse directed us to go to hospital immediately.

At the hospital, the emergency room physician informed my friend that it was most likely a migraine and I should take aspirin and rest. When my friend insisted that this was far more severe than anything he’d ever witnessed the “doctor” told him that many people exaggerate symptoms in hopes of obtaining pain relievers…

I was given two aspirins and instructed to rest in an exam room. The ER doctor told my friend that the symptoms were residing and they would keep an eye on me for a while…. My friend instructed the staff “doctor” not to discharge me without calling him…so he could provide me a ride home.

Sometime later (I learned later… two in the morning) I was put into a taxicab and sent home.

I had another stroke at home and was taken to hospital by ambulance the next day. I was paralyzed from the waist down and had no feeling or motor control on my left side. At the hospital a “doctor” attempted a spinal tap to extract fluid from my spinal column but after three tries was unable to insert the needle properly through my vertebrae and I recommended getting someone else in the hospital to perform the procedure. A different person came to the exam room and managed to perform the test on the first try, finding blood had run down from my head into my spinal column. I was admitted to hospital at that point and some time later (hours) experienced another stroke that left me blind.

The question begging to be asked is, ‘If I had received better care and been hospitalized immediately at the outset would that have reduced the damage?”

I’m convinced that I would not have remained partially paralyzed and left unable to work had I received better care at the first contact with the local hospital. I have now been a recipient of ODSP benefits since 1997 and although regained my eyesight and significant mobility, remain unable to work or enjoy a life in any way similar to the life I had before the incidents.

If you ever have the need to attend emergency room at the University Hospital in London Ontario Canada, go anywhere else you are able!

I have not been able to find an attorney willing to sue these butchers and have been told that the London Health Sciences Corporation would spend millions to defend their case while a lawyer working on behalf of a hemiplegic would be unable to match the money and would therefore not be enthusiastic in trying the case.

Canadians have been convinced that they live in a country with the best medical services in the world…..and embraced these lies with gusto…

London Ontario is home to the University of Western Ontario and London’s University Hospital is a teaching hospital attended by students from all over the world.

You can believe what you will, but in my opinion, University Hospital is responsible for exacerbating my situation and as a cog in the myth of both modern “medicine” and the wealthy elite of this community, has escaped its responsibilities and is perpetrating a fraud on the people of London and the taxpayers of Canada.

I wouldn’t send my cat to London’s University Hospital, since I love my cat enough to protect him from the witch-doctors and con-men that call themselves’ “doctor”.

 

[snfu73]

Not meaning to take away from what happened to you...which is not good...I do want to say that I have had colon cancer, a heart condition and bipolar disorder, so I've used the medical system a great deal, and I have had exceptional care. I think the unfortunate incidents, from my own experiences and what I have seen aren't overly common. That's not to say that when they happen, they should be excused, or diminished in anyway. There is no such thing as a perfect system. I believe that we have a good system here in Canada, and good care, and good doctors for the most part. But, there are some not so good doctors. Also, it's important to note that doctors aren't gods...they aren't miracle workers...and they aren't always right. Mistakes will be made. Again...not excusing anything...but, it's still true.

 

[MikeyDB]

I'm not looking for miracle workers here...I'm looking for accountability...

Something that's in very short supply in the Canadian medical circus...

 

[snfu73]

I'm not looking for miracle workers here...I'm looking for accountability...

Something that's in very short supply in the Canadian medical circus...

What is the reason attorneys won't accept the case?

 

[tracy]

It can be difficult for lawsuits to be won. You basically have to prove that a prudent doctor/nurse would have acted differently than yours did and their actions or lack of action caused injury. If upon reviewing medical records the doctor's decision was reasonable based on his assessment then he is not considered negligent, meaning if everything about his presentation screamed migraine, it isn't negligent to diagnose him with that and try to treat him for that (missing an LP isn't something I'd call negligence, I've seen excellent docs miss before). I don't know if he even could sue at this point because of the time it's been since the incident. It's unfortunate that there are bad practitionners out there. I don't think they are the majority at all, but one bad experience with them can have devastating results.

 

[snfu73]

It can be difficult for lawsuits to be won. You basically have to prove that a prudent doctor/nurse would have acted differently than yours did and their actions or lack of action caused injury. If upon reviewing medical records the doctor's decision was reasonable based on his assessment then he is not considered negligent, meaning if everything about his presentation screamed migraine, it isn't negligent to diagnose him with that and try to treat him for that (missing an LP isn't something I'd call negligence, I've seen excellent docs miss before). I don't know if he even could sue at this point because of the time it's been since the incident. It's unfortunate that there are bad practitionners out there. I don't think they are the majority at all, but one bad experience with them can have devastating results.

Is that in Canada though...or is that the way it is in the US? I mean, you are most likely right...and I am not doubting you...it probably is true in Canada...but I don't know.

 

[tracy]

Is that in Canada though...or is that the way it is in the US? I mean, you are most likely right...and I am not doubting you...it probably is true in Canada...but I don't know.

Yep in Canada. It's basically the same here in the US, though nuisance lawsuits are still often filed. I think that rule is fair actually. Health care workers can't be held to impossibly high standards, so the "prudent doctor/nurse" idea is a good one. It just means you can't sue me if I did everything another prudent nurse would have done based on the information available at the time. I don't have to be in possession of a crystal ball or be perfect, I just have to be prudent and competent. His case could have been negligence or it may just have been a terribly unfortunate event that could have happened everywhere, there is no way for me to know cause that isn't what I do for a living. The attorneys may feel it was the latter so they were reluctant to take it on. In really obvious cases of negligence, docs and hospital systems often want to settle to avoid the negative publicity but that does vary. Patients also have the right to complain to the hospital and to health care workers' regulating bodies if they feel they received poor care.

I think people sometimes sue because of the way they are treated, not the medical aspect but they often feel disrespected. I've seen mistakes made (cause like you said we aren't perfect) and practitionners who apologize and ask forgiveness from patients and families receive it more often than not. My dad was almost killed by a clear medical error and we never sued because his doctor was sorry. He said it and he meant it and suing him wasn't important to us anymore. Luckily my dad wasn't caused permanent injury either. I've also seen lawsuits which were entirely without merit filed down here because the family could afford to pay lawyers' bills forever and they just couldn't accept that their bad outcome was inevitable. Their memory of events is often very far from reality too. It frustrates me that sometimes true cases of negligence go unpunished and other cases where the healthcare team acted responsibly get brought to court.