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Pseudofracture: An Acute Peripheral Tissue Trauma Model
10:08

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Is there a 'weekend effect' in major trauma?

David Metcalfe1, Daniel C Perry2, Omar Bouamra3

  • 1Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.

Emergency Medicine Journal : EMJ
|November 1, 2016
PubMed
Summary

The weekend effect, where patients admitted to hospital on weekends have worse outcomes, was not observed in a major trauma service. This suggests that consistent clinical services throughout the week may eliminate this disparity.

Keywords:
TraumaTrauma, epidemiologymajor trauma management

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Area of Science:

  • Trauma Surgery
  • Health Services Research
  • Patient Outcomes

Background:

  • Previous studies indicate poorer patient outcomes for hospital admissions on weekends.
  • The 'weekend effect' is hypothesized to be mitigated by consistent clinical services.
  • This study investigates the weekend effect in a consultant-led major trauma service operating 24/7.

Purpose of the Study:

  • To determine if a weekend effect exists within an all-hours major trauma service.
  • To assess the impact of weekend admissions on patient outcomes.
  • To evaluate the effectiveness of continuous major trauma care.

Main Methods:

  • Observational cohort study utilizing data from 22 English major trauma centers.
  • Inclusion criteria: major trauma patients admitted for ≥3 days, to high-dependency, or deceased.
  • Outcome measures: length of stay, in-hospital mortality, Glasgow Outcome Score (GOS), and secondary transfers.

Main Results:

  • Analysis of 49,070 patients, with 45.3% having an Injury Severity Score (ISS) >15.
  • No significant association found between weekend or nighttime admission and increased length of stay, worse GOS, or higher in-hospital mortality.
  • Higher odds of secondary transfer to a major trauma center (MTC) were observed at night (aOR 2.05), but not during weekend days (aOR 1.09).

Conclusions:

  • The weekend effect is not detectable in a regionalized, all-hours major trauma service after adjusting for confounders.
  • Consistent clinical service delivery throughout the week appears to negate the adverse outcomes previously associated with weekend hospital admissions.
  • These findings support the model of centralized, continuous care for major trauma patients.