Abstract| Volume 41, ISSUE 6, P744, December 2011

Weekend and Night Outcomes in a Statewide Trauma System

Carr BG, Wiebe DJ, Reilly PM, et al. Arch Surg 2011;146:810–7.
      The differential quality of “off-hours” care for critical conditions has been cited repeatedly in the literature across a spectrum of diseases and specialties. In this article, the authors sought to evaluate whether trauma patients in a well-established regional trauma system were also subject to the so-called “weekend effect.” Retrospective data were collected on all adult trauma patients admitted to an accredited trauma center in Pennsylvania over a 5-year period, looking at in-house mortality, length of stay (LOS), and delay over 2 h to laparotomy or craniotomy. The data were subdivided by patient arrival time as weekday, weeknight, or weekend admissions. In unadjusted analyses of the data, the authors found that patients presenting on weeknights had a higher in-hospital mortality rate than patients presenting on weekdays (7.5% vs. 6.6%; odds ratio 1.15; 95% confidence interval [CI] 1.07–1.22), but this difference was not found after adjustment for comorbid conditions and injury severity. Interestingly, patients presenting on the weekend actually had lower in-hospital mortality in the adjusted analysis (incidence rate ratio 0.89; 95% CI 0.81–0.97). However, in both adjusted and unadjusted analyses, LOS was increased for patients presenting during nights or weekends. None of the analyses demonstrated an increased delay to laparotomy or craniotomy for patients presenting at off hours.
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