A population based study on the night-time effect in trauma care.
Stefano Di Bartolomeo1, Massimiliano Marino2, Chiara Ventura2
1Department of Clinical Governance, Regional Agency for Health and Social Care of Emilia-Romagna, Bologna, Italy Department of Anaesthesia, Azienda Ospedaliero-Universitaria, Udine, Italy Department of Research and Development, Norwegian Air Ambulance Foundation, Norway.
Emergency Medicine Journal : EMJ
|July 2, 2013
Summary
The off-hour effect, or increased mortality during night-time admissions, was demonstrated in trauma care for the first time. This effect was significantly higher for transferred patients, highlighting a critical area for trauma system improvement.
Area of Science:
- Trauma Care
- Emergency Medicine
- Health Services Research
Background:
- The off-hour effect, characterized by increased mortality for patients admitted outside normal working hours, has not been previously established in trauma care.
- Most prior studies excluded transferred trauma cases, potentially masking this effect.
- Transferred patients present unique challenges to trauma systems, suggesting their care may be more susceptible to off-hour disparities.
Purpose of the Study:
- To investigate the association between night-time admission and mortality in major trauma patients.
- To determine if the off-hour effect is present in trauma care and if it disproportionately affects transferred patients.
Main Methods:
- A retrospective, population-based cohort study was conducted in an Italian region.
- Mortality data for 1940 major trauma cases in 2011 were analyzed, comparing daytime and night-time admissions.
- Logistic regression, adjusted for demographics and injury severity (TMPM-ICD9), was used, stratified by transfer status.
Main Results:
- Night-time admission was significantly associated with increased mortality (OR=1.49; 95% CI 1.05 to 2.11).
- This night-time effect was substantially more pronounced in acutely transferred patients (OR=3.71; 95% CI 1.11 to 12.43).
- 105 out of 1940 major trauma cases were identified as acutely transferred.
Conclusions:
- The study demonstrates, for the first time, a significant night-time effect on mortality in trauma care.
- This effect is most pronounced in transferred trauma patients, suggesting a critical vulnerability in trauma systems.
- The inclusion of population-based data, encompassing patients not directly accessing trauma centers, may have contributed to these findings.
