Night admission is an independent risk factor for mortality in trauma patients - a systemic error approach

Barbosa, Leonardo de Souza; Júnior, Geibel Santos Reis Dos; Chaves, Ricardo Zantieff Topolski; Solla, Davi Jorge Fontoura; Canedo, Leonardo Fernandes; Cunha, André Gusmão

doi:10.1590/0100-69912015004003

Cited by 13 publications

(8 citation statements)

References 21 publications

(66 reference statements)

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“…It is interesting to note that the same country data might provide different results at the national, regional, and institutional levels. Our observations agree with Hirose's findings in Japan and others, such as the report by Barbosa et al, USA [29], who reported increased mortality during nights but not on weekends, similar to this cohort.…”

Section: Discussionsupporting

confidence: 94%

The Patterns and Impact of Off-Working Hours, Weekends and Seasonal Admissions of Patients with Major Trauma in a Level 1 Trauma Center

Abdelrahman

Al-Thani

Khan

et al. 2021

IJERPH

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Background: The trauma incidence follows specific patterns in different societies and is expected to increase over the weekend and nighttime. We aimed to explore and analyze the incidence, pattern, and severity of trauma at different times (working hours vs. out off-working hours, weekdays vs. weekends and season). Methods: A retrospective analysis was conducted at a level 1 trauma facility in Qatar. All injured patients admitted between June 2017 and May 2018 were included. The data were analyzed to determine whether outcomes and care parameters of these patients differed between regular working hours and off-working hours, weekdays vs. weekends, and between season intervals. Results: During the study period, 2477 patients were admitted. A total of 816 (32.9%) patients presented during working hours and 1500 (60.6%) during off-working hours. Off-working hours presentations differed significantly with the injury severity score (ISS) (p < 0.001), ICU length of stay (p = 0.001), blood transfusions (p = 0.001), intubations (p = 0.001), mortality rate (9.7% vs. 0.7%; p < 0.001), and disposition to rehabilitation centers. Weekend presentations were significantly associated with a higher ISS (p = 0.01), Priority 1 trauma activation (19.1% vs. 14.7%; p = 0005), and need for intubation (21% vs. 16%; p = 0.002). The length of stay (ICU and hospital), mortality, and disposition to rehabilitation centers and other clinical parameters did not show any significant differences. No significant seasonal variation was observed in terms of admissions at the trauma center. Conclusions: The off-working hours admission showed an apparent demographic effect in involved mechanisms, injury severity, and trauma activations, while outcomes, especially the mortality rate, were significantly different during nights but not during the weekends. The only observed seasonal effect was a decrease in the number of admissions during the summer break.

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Section: Discussionsupporting

confidence: 94%

The Patterns and Impact of Off-Working Hours, Weekends and Seasonal Admissions of Patients with Major Trauma in a Level 1 Trauma Center

Abdelrahman

Al-Thani

Khan

et al. 2021

IJERPH

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“…Barbosa et al. 11 showed in their single-centre study involving 563 patients that mortality was higher among patients treated at night despite risk adjustment. No statement was made about injury severity (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies show that this factor does not have an aggravating effect, 7 , 8 , 9 , 10 while others show that it has a negative influence. 11 , 12 , 13…”

Section: Introductionmentioning

confidence: 99%

Why do some trauma patients die while others survive? A matched-pair analysis based on data from Trauma Register DGU®

Bieler

Paffrath

Schmidt

et al. 2020

Chinese Journal of Traumatology

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Purpose The mortality rate for severely injured patients with the injury severity score (ISS) ≥16 has decreased in Germany. There is robust evidence that mortality is influenced not only by the acute trauma itself but also by physical health, age and sex. The aim of this study was to identify other possible influences on the mortality of severely injured patients. Methods In a matched-pair analysis of data from Trauma Register DGU®, non-surviving patients from Germany between 2009 and 2014 with an ISS≥16 were compared with surviving matching partners. Matching was performed on the basis of age, sex, physical health, injury pattern, trauma mechanism, conscious state at the scene of the accident based on the Glasgow coma scale, and the presence of shock on arrival at the emergency room. Results We matched two homogeneous groups, each of which consisted of 657 patients (535 male, average age 37 years). There was no significant difference in the vital parameters at the scene of the accident, the length of the pre-hospital phase, the type of transport (ground or air), pre-hospital fluid management and amounts, ISS, initial care level, the length of the emergency room stay, the care received at night or from on-call personnel during the weekend, the use of abdominal sonographic imaging, the type of X-ray imaging used, and the percentage of patients who developed sepsis. We found a significant difference in the new injury severity score, the frequency of multi-organ failure, hemoglobine at admission, base excess and international normalized ratio in the emergency room, the type of accident (fall or road traffic accident), the pre-hospital intubation rate, reanimation, in-hospital fluid management, the frequency of transfusion, tomography (whole-body computed tomography), and the necessity of emergency intervention. Conclusion Previously postulated factors such as the level of care and the length of the emergency room stay did not appear to have a significant influence in this study. Further studies should be conducted to analyse the identified factors with a view to optimising the treatment of severely injured patients. Our study shows that there are significant factors that can predict or influence the mortality of severely injured patients.

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“…Barbosa et al, for example, identified that operative trauma was more likely to occur at night, over the weekends, and was associated with greater mortality in their Brazilian trauma population. More specifically, they identified admission at night as an independent risk factor for surgical mortality in trauma patients [ 1 ]. Studies in the United Kingdom and Canada conversely found no difference in mortality between patients presenting on nights and/or weekends compared to those arriving at “normal” hours, which may reflect their highly developed multihospital acute care and trauma system [ 2 , 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…In fact, the current literature is divided regarding the effect of time of day on trauma patient outcomes. Multiple countries including Japan, Canada, the United Kingdom, Germany, Brazil, and the United States have all performed retrospective studies using their trauma data banks over varied time frames attempting to confirm or refute the above belief [ [1] , [2] , [3] , [4] , [5] , [6] ]. However, none of these studies can agree if time of day truly impacts patient outcomes, and none have separated blunt from penetrating trauma.…”

Section: Introductionmentioning

confidence: 99%

They only come out at night: Impact of time of day on outcomes after penetrating abdominal trauma

Lenart

Lewis

Sharpe

et al. 2020

Surgery Open Science

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Background Patients who present at night following penetrating abdominal trauma are thought to have more severe injuries and increased risk for morbidity and mortality. The current literature is at odds regarding this belief. The purpose of this study was to evaluate time of day on outcomes following laparotomy for penetrating abdominal trauma. Methods Patients undergoing laparotomy following penetrating abdominal trauma over a 12-month period at a level I trauma center were stratified by age, sex, severity of shock, injury, operative complexity, and time of day (DAY = 0700–1900, NIGHT = 1901–0659). Outcomes of damage control laparotomy, ventilator days, intensive care unit length of stay, hospital length of stay, morbidity, and mortality were compared between DAY and NIGHT. Results A total of 210 patients were identified: 145 (69%) comprised NIGHT, and 65 (31%) comprised DAY. Overall mortality was 2.9%. Both injury severity and intraoperative transfusions were increased with NIGHT with no difference in morbidity (37% vs 40%, P = 0.63) or mortality (2.1% vs 4.6%, P = 0.31). Adjusting for sex, time of day, injury severity, and operative complexity, only abdominal abbreviated injury severity (odds ratio 1.46; 95% confidence interval 1.07–1.99, P = .019) and operative transfusions (odds ratio 1.18; 95% confidence interval 1.09–1.28, P < .0001) were identified as independent predictors of damage control laparotomy using multivariable logistic regression (area under the curve 0.96). Conclusion The majority of operative penetrating abdominal trauma occurs at night with increased injury burden, more operative transfusions, and increased use of damage control laparotomy with no difference in morbidity and mortality . Outcomes at a fully staffed and operational trauma center should not be impacted by time of day.

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Night admission is an independent risk factor for mortality in trauma patients - a systemic error approach

Cited by 13 publications

References 21 publications

The Patterns and Impact of Off-Working Hours, Weekends and Seasonal Admissions of Patients with Major Trauma in a Level 1 Trauma Center

The Patterns and Impact of Off-Working Hours, Weekends and Seasonal Admissions of Patients with Major Trauma in a Level 1 Trauma Center

Why do some trauma patients die while others survive? A matched-pair analysis based on data from Trauma Register DGU®

They only come out at night: Impact of time of day on outcomes after penetrating abdominal trauma

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