Faculty Collaboration Database

Pulmonary embolism: the weekend effect. Chest 2012 Sep;142(3):690-696

Date

03/31/2012

Pubmed ID

22459777

Pubmed Central ID

PMC4694190

DOI

10.1378/chest.11-2663

Scopus ID

2-s2.0-84865851848 (requires institutional sign-in at Scopus site)   72 Citations

Abstract

BACKGROUND: 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.

METHODS: We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample for the years 2000 to 2008 to identify people with a principal discharge diagnosis of pulmonary embolism. We classified admissions as weekend if they occurred between midnight Friday and midnight Sunday. We compared all-cause in-hospital mortality between weekend and weekday admissions and investigated the timing of inferior vena cava (IVC) filter placement and thrombolytic infusion as potential explanations for differences in mortality.

RESULTS: Unadjusted mortality was higher for weekend admissions than weekday admissions (OR, 1.19; 95% 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 patients who received an IVC filter, a larger proportion of those admitted on a weekday than on the weekend received it on their first hospital day (38% vs 29%, P < .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 pulmonary embolism suggests 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.

Author List

Nanchal R, Kumar G, Taneja A, Patel J, Deshmukh A, Tarima S, Jacobs ER, Whittle J, from the Milwaukee Initiative in Critical Care Outcomes Research (MICCOR) Group of Investigators

Authors

Rahul Sudhir Nanchal MD Professor in the Medicine department at Medical College of Wisconsin
Jayshil Patel MD Associate Professor in the Medicine department at Medical College of Wisconsin
Amit Taneja MD Assistant Professor in the Medicine department at Medical College of Wisconsin
Sergey S. Tarima PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Jeffrey Whittle MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Databases, Factual
Female
Hospital Mortality
Humans
Inpatients
Length of Stay
Male
Middle Aged
Patient Admission
Pulmonary Embolism
Retrospective Studies
Thrombolytic Therapy
Time Factors
Time-to-Treatment
Treatment Outcome
Vena Cava Filters
Young Adult