We appreciate the interest demonstrated by Dr Girard and his colleagues in our work.1 We agree that we cannot completely rule out a selection bias as a mechanism of our findings and have acknowledged this in the “Limitations” section of our article. Despite robustly adjusting for severity of illness in our multivariable regression model, we cannot exclude residual confounding. The “Monday Effect,” or deferred care for relatively minor pulmonary embolism (PE), as suggested by Dr Girard and colleagues, is an interesting concept and deserves further study. Unfortunately, our data sources do not allow us to make such a determination. The National Inpatient Sample has a variable that indicates whether the admission was on a weekday or weekend but not for specific days of the week. However, it is unlikely that this phenomenon is solely responsible for our findings. Delaying care for a potential life-threatening disease, by up to >2 days in some cases, would lead to an increase in severity of illness and by extension mortality on weekdays in at least some such people. This would bias our results toward finding no differences in mortality between weekends and weekdays.