Pulmonary Embolism: The Weekend Effect.
Chest. 2012 Mar 29;
Authors: Nanchal R, Kumar G, Taneja A, Patel J, Deshmukh A, Tarima S, Jacobs E, Whittle J,
ABSTRACT CONTEXT:Pulmonary embolism is a common, often fatal condition that requires timely recognition and rapid institution of therapy. Previous studies have documented worse outcomes for weekend admissions for a variety of time sensitive medical conditions. This phenomenon has not been clearly demonstrated for pulmonary embolism. OBJECTIVE:We used the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (NIS) for the years 2000 to 2008 to identify persons with a principal discharge diagnosis of pulmonary embolism. We classified them as weekend admissions if they occurred between midnight Friday and midnight Sunday. We compared all cause in- hospital mortality between weekend and weekday admissions; we investigated the timing of inferior vena cava (IVC) filter placement and thrombolytic infusion as potential explanations for any difference in mortality. RESULTS:Unadjusted mortality was higher for weekend than weekday admission (Odds Ratio (OR) 1.19; 95% Confidence Interval (CI) 1.13 - 1.24). This increase in mortality remained statistically significant after controlling for potential confounding variables (OR 1.17; 95% CI 1.11 - 1.22). Among persons who received an IVC filter, a larger proportion of weekday than weekend admissions received it on their first hospital day (38% vs. 29%, p < 0.001). The timing of thrombolytic therapy did not differ between weekday and weekend admissions. CONCLUSIONS:Weekend admissions for pulmonary embolism were associated with higher mortality than weekday admissions. Our finding that IVC filter placement occurred later in the hospital course for patients admitted on weekends with PE suggest differences in the timeliness of diagnosis and treatment between weekday and weekend admissions. Regardless of cause, physicians should be aware that weekend admissions for pulmonary embolism have a 20% increased risk of death and warrant closer attention than provided during the week.
PMID: 22459777 [PubMed - as supplied by publisher]