The off-hour effect among severe trauma patients: a nationwide cohort study in Japan

Aoki, Makoto; Abe, Toshikazu; Matsumura, Yosuke; Hagiwara, Shinji; Saitoh, Daizoh; Oshima, Kiyohiro

doi:10.1007/s00595-020-02027-1

Cited by 3 publications

(2 citation statements)

References 17 publications

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“…In contrast, several observational trials reported no inferior outcomes among patients presenting during nighttime compared to those admitted during the day [21][22][23][24][25], even with high patient loads [26]. A number of studies investigating the national trauma system of a specific country also reported no differences in mortality or patient outcomes when comparing the time of day [27][28][29][30]. It must be noted that differences in the structure and system of prehospital care between countries may hamper the comparison of results.…”

Section: Discussionmentioning

confidence: 99%

Effect of Daytime versus Nighttime on Prehospital Care and Outcomes after Severe Traumatic Brain Injury

Bulte,

Mansvelder,

Loer

et al. 2024

JCM

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Background/Objectives: Severe traumatic brain injury (TBI) is a frequent cause of morbidity and mortality worldwide. In the Netherlands, suspected TBI is a criterion for the dispatch of the physician-staffed helicopter emergency medical services (HEMS) which are operational 24 h per day. It is unknown if patient outcome is influenced by the time of day during which the incident occurs. Therefore, we investigated the association between the time of day of the prehospital treatment of severe TBI and 30-day mortality. Methods: A retrospective analysis of prospectively collected data from the BRAIN-PROTECT study was performed. Patients with severe TBI treated by one of the four Dutch helicopter emergency medical services were included and followed up to one year. The association between prehospital treatment during day- versus nighttime, according to the universal daylight period, and 30-day mortality was analyzed with multivariable logistic regression. A planned subgroup analysis was performed in patients with TBI with or without any other injury. Results: A total of 1794 patients were included in the analysis, of which 1142 (63.7%) were categorized as daytime and 652 (36.3%) as nighttime. Univariable analysis showed a lower 30-day mortality in patients with severe TBI treated during nighttime (OR 0.74, 95% CI 0.60–0.91, p = 0.004); this association was no longer present in the multivariable model (OR 0.82, 95% CI 0.59–1.16, p = 0.262). In a subgroup analysis, no association was found between mortality rates and the time of prehospital treatment in patients with combined injuries (TBI and any other injury). Patients with isolated TBI had a lower mortality rate when treated during nighttime than when treated during daytime (OR 0.51, 95% CI 0.34–0.76, p = 0.001). Within the whole cohort, daytime versus nighttime treatments were not associated with differences in functional outcome defined by the Glasgow Outcome Scale. Conclusions: In the overall study population, no difference was found in 30-day mortality between patients with severe TBI treated during day or night in the multivariable model. Patients with isolated severe TBI had lower mortality rates at 30 days when treated at nighttime.

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Section: Discussionmentioning

confidence: 99%

Effect of Daytime versus Nighttime on Prehospital Care and Outcomes after Severe Traumatic Brain Injury

Bulte,

Mansvelder,

Loer

et al. 2024

JCM

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“…Therefore, there is a need to conduct such a study in each region 3 . Previously, Japanese researchers investigated the association between "off-hour" admission and patient outcomes for several critical diseases among adults and concluded no significant correlation [4][5][6][7][8] . Our study provided similar findings among children.…”

Section: Discussionmentioning

confidence: 99%

Association between off-hour admission of critically ill children to intensive care units and mortality in a Japanese registry

Kido

Iwagami

Abe

et al. 2021

Sci Rep

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Limited information exists regarding the effect of off-hour admission among critically ill children. To evaluate whether children admitted to intensive care units (ICUs) in off-hour have worse outcomes, we conducted a cohort study in 2013–2018 in a multicenter registry in Japan. Pediatric (age < 16 years) unplanned ICU admissions were divided into regular-hour (daytime on business days) or off-hour (others). Mortality and changes in the functional score at discharge from the unit were compared between the two groups. We established multivariate logistic regression models to examine the independent association between off-hour admission and outcomes. Due to the small number of outcomes, two different models were used. There were 2512 admissions, including 757 for regular-hour and 1745 for off-hour. Mortality rates were 2.4% (18/757) and 1.9% (34/1745) in regular-hour and off-hour admissions, respectively. There was no significant association between off-hour admission and mortality both in model 1 adjusting for age, sex, and Pediatric Index of Mortality 2 (adjusted odds ratio [aOR] 0.89, 95% confidence interval [CI] 0.46–1.72) and in model 2 adjusting for propensity score predicting off-hour admission (aOR 1.05, 95% CI 0.57–1.91). In addition, off-hour admission did not show an independent association with deterioration of functional score.

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The association of off-hour vs. on-hour intensive care unit admission time with mortality in patients with cardiogenic shock: a retrospective multi-centre analysis

Naumann,

Fischer,

Gmeiner

et al. 2024

European Heart Journal: Acute Cardiovascular Care

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Background Studies have shown a so-called off-hour effect for many different diseases, but data are scarce concerning cardiogenic shock. We therefore assessed the association of off-hour vs. on-hour intensive care unit (ICU) admission with 30-day mortality in patients with cardiogenic shock. Methods In total, 1720 cardiogenic shock patients (666 admitted during off-hours) from two large university hospitals in Germany were included in retrospect. Results An admission during off-hours was associated with an increased 30-day mortality compared to an admission during on-hours (crude mortality 48% vs. 41%, HR 1.17 (1.03–1.33), p = 0.017). This effect remained significant after propensity score matching (p = 0.023). Neither patients with a combined SCAI stage D and E (p = 0.088) or C (p = 0.548) nor those requiring cardiopulmonary resuscitation (p = 0.114) had a higher mortality at off-hour admission. In contrast, those without veno-arterial extracorporeal membrane oxygenation (VA-ECMO) (HR 1.17 (1.00–1.36), p = 0.049), without acute myocardial infarction (HR 1.27 (1.02–1.56), p = 0.029) or a with combined SCAI stage A and B (HR 2.23 (1.08–4.57), p = 0.025) had an increased mortality at off-hour admission. Conclusion Our study showed an increased mortality in patients with cardiogenic shock admitted during off-hours especially in those with a milder onset of disease. This stresses the importance of a thorough workup of each patient especially at times of limited resources, the menace of underestimating the severity of cardiogenic shock and the need for an improved twenty-four seven available risk stratification.

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The off-hour effect among severe trauma patients: a nationwide cohort study in Japan

Cited by 3 publications

References 17 publications

Effect of Daytime versus Nighttime on Prehospital Care and Outcomes after Severe Traumatic Brain Injury

Effect of Daytime versus Nighttime on Prehospital Care and Outcomes after Severe Traumatic Brain Injury

Association between off-hour admission of critically ill children to intensive care units and mortality in a Japanese registry

The association of off-hour vs. on-hour intensive care unit admission time with mortality in patients with cardiogenic shock: a retrospective multi-centre analysis

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