Major trauma: Does weekend attendance increase 30-day mortality?
Adolescent
Adult
After-Hours Care
Aged
Cause of Death
Child
Emergency Service, Hospital
Female
Hospital Mortality
/ trends
Hospitalization
/ statistics & numerical data
Humans
Male
Middle Aged
Retrospective Studies
Time-to-Treatment
/ statistics & numerical data
United Kingdom
/ epidemiology
Wounds and Injuries
/ mortality
Young Adult
Head injury
Mortality
Trauma
Weekend effect
Journal
Injury
ISSN: 1879-0267
Titre abrégé: Injury
Pays: Netherlands
ID NLM: 0226040
Informations de publication
Date de publication:
Feb 2019
Feb 2019
Historique:
received:
30
05
2018
revised:
27
09
2018
accepted:
04
12
2018
pubmed:
8
1
2019
medline:
27
6
2019
entrez:
8
1
2019
Statut:
ppublish
Résumé
Differing mortality rates according to day of hospital admission is an area of debate, where a supposed increased rate of mortality with weekend admissions has been termed "the weekend effect". We sought to identify the 30-day mortality rates in major trauma patients attending our Major Trauma Centre (MTC) and the underlying reasons for these. A retrospective review of data retrieved from the Trauma Audit and Research Network (TARN) database was undertaken for all patients attending between January 2013 and July 2015 with an Injury Severity Score of 9 or higher. 30-day mortality rates were calculated according to day of attendance. 1424 patients met the inclusion criteria. There was no significant difference in 30-day mortality between weekend attendances (7.8%) compared to those on a weekday (7.7%). 30-day mortality was highest in patients attending on Fridays (10.8%) and lowest in those attending on Sundays (5.5%). A significantly higher 30-day mortality rate was seen in patients attending on a Friday or Saturday (10.4%) compared to those attending Sunday to Thursday (6.6%) (RR 1.548). Patients with a head injury as their most serious injury on a Friday or Saturday were more likely to have GCS < 9 (34.7% vs 24.4%) and more likely to die (22.7% vs 12%) than those attending Sunday to Thursday. There is no significant difference in 30-day mortality when directly comparing weekday to weekend attendances. There is a significantly higher mortality on Friday and Saturday compared to remainder of the week which appears to be explained by a greater severity of head trauma. This study provides no evidence of a "weekend effect" in this MTC but the increased severity of and mortality from head injury identified on Friday and Saturday is a public health concern which warrants further investigation.
Sections du résumé
BACKGROUND
BACKGROUND
Differing mortality rates according to day of hospital admission is an area of debate, where a supposed increased rate of mortality with weekend admissions has been termed "the weekend effect". We sought to identify the 30-day mortality rates in major trauma patients attending our Major Trauma Centre (MTC) and the underlying reasons for these.
METHODS
METHODS
A retrospective review of data retrieved from the Trauma Audit and Research Network (TARN) database was undertaken for all patients attending between January 2013 and July 2015 with an Injury Severity Score of 9 or higher. 30-day mortality rates were calculated according to day of attendance.
RESULTS
RESULTS
1424 patients met the inclusion criteria. There was no significant difference in 30-day mortality between weekend attendances (7.8%) compared to those on a weekday (7.7%). 30-day mortality was highest in patients attending on Fridays (10.8%) and lowest in those attending on Sundays (5.5%). A significantly higher 30-day mortality rate was seen in patients attending on a Friday or Saturday (10.4%) compared to those attending Sunday to Thursday (6.6%) (RR 1.548). Patients with a head injury as their most serious injury on a Friday or Saturday were more likely to have GCS < 9 (34.7% vs 24.4%) and more likely to die (22.7% vs 12%) than those attending Sunday to Thursday.
CONCLUSION
CONCLUSIONS
There is no significant difference in 30-day mortality when directly comparing weekday to weekend attendances. There is a significantly higher mortality on Friday and Saturday compared to remainder of the week which appears to be explained by a greater severity of head trauma.
IMPLICATIONS
CONCLUSIONS
This study provides no evidence of a "weekend effect" in this MTC but the increased severity of and mortality from head injury identified on Friday and Saturday is a public health concern which warrants further investigation.
Identifiants
pubmed: 30612750
pii: S0020-1383(18)30732-0
doi: 10.1016/j.injury.2018.12.007
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
351-357Informations de copyright
Copyright © 2019 Elsevier Ltd. All rights reserved.