Weekend and night outcomes in a statewide trauma system

Area of Science:

• Trauma surgery
• Emergency medicine
• Health services research

Background:

• The
• weekend effect
• describes potential disparities in healthcare outcomes between weekdays and weekends.
• Mature trauma systems aim to standardize care, but temporal variations may persist.

Purpose of the Study:

• To investigate if mortality and clinical outcomes differ for injured patients presenting to trauma centers during weeknights and weekends versus weekdays.

Main Methods:

• Retrospective cohort study of 90,461 patients over 5 years within the Pennsylvania trauma system.
• Analysis included patients treated at level I, II, or III trauma centers.
• Primary outcomes were in-hospital mortality, time to procedures (laparotomy, craniotomy), and length of stay (ICU and hospital).

Main Results:

• No significant difference in mortality was observed for patients presenting on weeknights compared to weekdays.
• Patients presenting on weekends had lower in-hospital mortality (OR=0.89; 95% CI, 0.81-0.97) compared to weekdays.
• Weeknight presentations were associated with longer ICU and hospital stays, while weekend presentations were linked to longer ICU stays but not hospital stays. No delays in critical procedures were noted.

Conclusions:

• Mortality rates are comparable for injured patients presenting on weeknights versus weekdays, with lower mortality on weekends.
• The robust trauma system design appears protective against the weekend effect, suggesting successful standardization of care.
• Findings inform strategies for emergency care-sensitive conditions beyond trauma.