Does the time of the day affect multiple trauma care in hospitals? A retrospective analysis of data from the TraumaRegister DGU®.
Admission
Day shift
Multiple trauma
Night shift
TraumaRegister DGU®
Journal
BMC emergency medicine
ISSN: 1471-227X
Titre abrégé: BMC Emerg Med
Pays: England
ID NLM: 100968543
Informations de publication
Date de publication:
13 11 2021
13 11 2021
Historique:
received:
25
03
2021
accepted:
22
10
2021
entrez:
14
11
2021
pubmed:
15
11
2021
medline:
15
12
2021
Statut:
epublish
Résumé
Optimal multiple trauma care should be continuously provided during the day and night. Several studies have demonstrated worse outcomes and higher mortality in patients admitted at night. This study involved the analysis of a population of multiple trauma patients admitted at night and a comparison of various indicators of the quality of care at different admission times. Data from 58,939 multiple trauma patients from 2007 to 2017 were analyzed retrospectively. All data were obtained from TraumaRegister DGU®. Patients were grouped by the time of their admission to the trauma center (6.00 am-11.59 am (morning), 12.00 pm-5.59 pm (afternoon), 6.00 pm-11.59 pm (evening), 0.00 am-5.59 am (night)). Incidences, patient demographics, injury patterns, trauma center levels and trauma care times and outcomes were evaluated. Fewer patients were admitted during the night (6.00 pm-11.59 pm: 18.8% of the patients, 0.00-5.59 am: 4.6% of the patients) than during the day. Patients who arrived between 0.00 am-5.59 am were younger (49.4 ± 22.8 years) and had a higher injury severity score (ISS) (21.4 ± 11.5) and lower Glasgow Coma Scale (GCS) score (11.6 ± 4.4) than those admitted during the day (12.00 pm-05.59 pm; age: 55.3 ± 21.6 years, ISS: 20.6 ± 11.4, GCS: 12.6 ± 4.0). Time in the trauma department and time to an emergency operation were only marginally different. Time to imaging was slightly prolonged during the night (0.00 am-5.59 am: X-ray 16.2 ± 19.8 min; CT scan 24.3 ± 18.1 min versus 12.00 pm- 5.59 pm: X-ray 15.4 ± 19.7 min; CT scan 22.5 ± 17.8 min), but the delay did not affect the outcome. The outcome was also not affected by level of the trauma center. There was no relevant difference in the Revised Injury Severity Classification II (RISC II) score or mortality rate between patients admitted during the day and at night. There were no differences in RISC II scores or mortality rates according to time period. Admission at night was not a predictor of a higher mortality rate. The patient population and injury severity vary between the day and night with regard to age, injury pattern and trauma mechanism. Despite the differences in these factors, arrival at night did not have a negative effect on the outcome.
Sections du résumé
BACKGROUND
Optimal multiple trauma care should be continuously provided during the day and night. Several studies have demonstrated worse outcomes and higher mortality in patients admitted at night. This study involved the analysis of a population of multiple trauma patients admitted at night and a comparison of various indicators of the quality of care at different admission times.
METHODS
Data from 58,939 multiple trauma patients from 2007 to 2017 were analyzed retrospectively. All data were obtained from TraumaRegister DGU®. Patients were grouped by the time of their admission to the trauma center (6.00 am-11.59 am (morning), 12.00 pm-5.59 pm (afternoon), 6.00 pm-11.59 pm (evening), 0.00 am-5.59 am (night)). Incidences, patient demographics, injury patterns, trauma center levels and trauma care times and outcomes were evaluated.
RESULTS
Fewer patients were admitted during the night (6.00 pm-11.59 pm: 18.8% of the patients, 0.00-5.59 am: 4.6% of the patients) than during the day. Patients who arrived between 0.00 am-5.59 am were younger (49.4 ± 22.8 years) and had a higher injury severity score (ISS) (21.4 ± 11.5) and lower Glasgow Coma Scale (GCS) score (11.6 ± 4.4) than those admitted during the day (12.00 pm-05.59 pm; age: 55.3 ± 21.6 years, ISS: 20.6 ± 11.4, GCS: 12.6 ± 4.0). Time in the trauma department and time to an emergency operation were only marginally different. Time to imaging was slightly prolonged during the night (0.00 am-5.59 am: X-ray 16.2 ± 19.8 min; CT scan 24.3 ± 18.1 min versus 12.00 pm- 5.59 pm: X-ray 15.4 ± 19.7 min; CT scan 22.5 ± 17.8 min), but the delay did not affect the outcome. The outcome was also not affected by level of the trauma center. There was no relevant difference in the Revised Injury Severity Classification II (RISC II) score or mortality rate between patients admitted during the day and at night. There were no differences in RISC II scores or mortality rates according to time period. Admission at night was not a predictor of a higher mortality rate.
CONCLUSION
The patient population and injury severity vary between the day and night with regard to age, injury pattern and trauma mechanism. Despite the differences in these factors, arrival at night did not have a negative effect on the outcome.
Identifiants
pubmed: 34773984
doi: 10.1186/s12873-021-00525-0
pii: 10.1186/s12873-021-00525-0
pmc: PMC8590232
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
134Informations de copyright
© 2021. The Author(s).
Références
Zentralbl Chir. 2016 Dec;141(6):660-665
pubmed: 26344501
Encephale. 2015 Sep;41(4 Suppl 1):S29-37
pubmed: 26746320
Crit Care. 2014 Sep 05;18(5):476
pubmed: 25394596
J Bone Joint Surg Am. 2012 Nov 7;94(21):1975-81
pubmed: 23014765
Crit Care Med. 2003 Mar;31(3):858-63
pubmed: 12626997
Injury. 2014 Oct;45 Suppl 3:S14-9
pubmed: 25284227
Lancet. 2006 May 27;367(9524):1747-57
pubmed: 16731270
PLoS One. 2018 Jan 5;13(1):e0190587
pubmed: 29304054
Injury. 2014 Oct;45 Suppl 3:S93-9
pubmed: 25284243
Chin J Traumatol. 2019 Jun;22(3):125-128
pubmed: 30956066
Biomed Res Int. 2019 Jun 20;2019:5936345
pubmed: 31321238
PLoS One. 2016 Feb 12;11(2):e0148844
pubmed: 26871937
J Trauma Manag Outcomes. 2009 Jul 27;3:8
pubmed: 19635157
Addiction. 2013 Aug;108(8):1428-38
pubmed: 23600629
Am J Med. 2004 Aug 1;117(3):151-7
pubmed: 15276592
Medicine (Baltimore). 2020 Jan;99(1):e18687
pubmed: 31895836
Sleep Biol Rhythms. 2017;15(3):217-225
pubmed: 28680341
Rev Col Bras Cir. 2015 Jul-Aug;42(4):209-14
pubmed: 26517794
Injury. 2009 Apr;40(4):362-7
pubmed: 19217104
Am J Surg. 2016 Nov;212(5):831-836
pubmed: 27263405
J Chir (Paris). 1999;136(5):240-51
pubmed: 10642637
Nature. 1997 Jul 17;388(6639):235
pubmed: 9230429
Lancet. 2010 Jun 19;375(9732):2121
pubmed: 20609935
N Engl J Med. 2007 Mar 15;356(11):1099-109
pubmed: 17360988
Acta Neurochir (Wien). 2006 Nov;148(11):1227-33
pubmed: 17102927
Ann Emerg Med. 1994 Nov;24(5):928-34
pubmed: 7978567
Lancet. 2009 Jun 13;373(9680):2011-2
pubmed: 19533832
Crit Care. 2014 Feb 27;18(1):114
pubmed: 24602204
JAMA. 2008 Feb 20;299(7):785-92
pubmed: 18285590
Acad Emerg Med. 2005 Jul;12(7):629-34
pubmed: 15995095
Ann Emerg Med. 2015 Jul;66(1):30-41, 41.e1-3
pubmed: 25596960
Scand J Trauma Resusc Emerg Med. 2014 Oct 31;22:62
pubmed: 25366718
Dtsch Arztebl Int. 2010 Jul;107(26):463-9
pubmed: 20644700
Wien Klin Wochenschr. 2016 Dec;128(Suppl 7):535-542
pubmed: 27896468
Prehosp Emerg Care. 2017 Jul-Aug;21(4):466-475
pubmed: 28489503
Chest. 2010 Jul;138(1):68-75
pubmed: 20418364
J Emerg Trauma Shock. 2011 Apr;4(2):178-83
pubmed: 21769202
J Trauma. 2003 May;54(5):973-8
pubmed: 12777912
Inj Prev. 2006 Apr;12(2):125-8
pubmed: 16595429
Am J Med. 2007 May;120(5):422-8
pubmed: 17466653
Crit Care Med. 2007 Jun;35(6):1477-83
pubmed: 17440421
Curr Osteoporos Rep. 2008 Dec;6(4):149-54
pubmed: 19032925