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Management of polytrauma patients in the UK: Is there a 'weekend effect'?
Vasileios Giannoudis1, Michalis Panteli2, Peter V Giannoudis2
1Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, UK.
Insights
This study found no increased mortality for weekend trauma admissions. Polytrauma patients admitted on weekends were younger and more hemodynamically unstable but had a lower mortality risk.
Area of Science:
- Trauma Surgery
- Emergency Medicine
- Public Health
Background:
- The
- weekend effect" hypothesis suggests increased mortality for hospital admissions during weekends.
- This study investigates this effect in polytrauma patients.
Purpose of the Study:
- To evaluate the impact of weekend admissions on the management and outcomes of polytrauma patients.
- To determine if a
- weekend effect" exists for polytrauma mortality and care timeliness.
Main Methods:
- Retrospective review of prospectively documented polytrauma patient data (Injury Severity Score > 15).
- Data collected from April 2013 to August 2015 at a UK Level I Major Trauma Centre.
- Comparison of weekday admissions (Group A) versus weekend admissions (Group B).
Main Results:
- 1030 patients met inclusion criteria; 731 were male.
- Weekend admissions (Group B) were younger and presented with more haemodynamic instability.
- No significant difference in time to CT scan; mortality was lower in Group B (10.8%) vs Group A (14.9%), RR 0.726.
Conclusions:
- Weekend polytrauma patients are younger, more severely injured, and present with greater haemodynamic instability.
- No evidence of a
- weekend effect" on mortality, time to CT, or time to operating room was found.
- A lower mortality risk was observed for patients admitted during the weekend.
Background/Purpose:
It has been suggested that hospital admission during weekends poses a risk for adverse outcomes and increased patient mortality, the so-called 'weekend effect'. We undertook an evaluation of the impact of weekend admissions to the management of polytraumatised patients, in a Level I Major Trauma Centre (MTC) in the UK.
Materials And Methods:
A retrospective review of prospectively documented data of polytrauma patients (injury severity score (ISS)>15), admitted between April 2013 and August 2015 was performed. Exclusion criteria included patients initially assessed in other institutions. All patients were initially managed at the emergency department (ED) according to ATLS® principles and underwent a trauma computed tomography (CT) scan, unless requiring immediate surgical intervention.
Results:
During the study period 1735 patients (pts) were admitted under the care of the MTC. Four hundred and five pts were excluded as they were transferred from other institutions and 300 pts were excluded as their ISS was less than 16. Overall 1030 patients met the inclusion criteria, out of which 731 were males. Comparing the two groups (Group A: weekday admissions (670), Group B: weekend admissions (360)), there was no difference in pts gender, mechanism of injury, GCS at presentation, need for intubation and time to CT. Patients admitted over the weekend were younger (p<0.01) and presented with haemodynamic instability more frequently (p=0.02). Time to operating room was also lower during the weekend, but this did not reach statistical significance (p=0.08). Mortality was lower in Group B: 39/360 pts (10.8%) compared to Group A: 100/670 pts (14.9%) (p=0.07). The relative risk (RR) of weekend mortality was calculated as 0.726 (95% CI: 0.513-1.027).
Discussion/Conclusion:
Weekend polytrauma patients appear to be younger, more severely injured and present with a higher incidence of haemodynamic instability (shock). Overall, we failed to identify a "weekend effect" in relation to mortality, time to CT and time to operating room. On the contrary, a lower risk of mortality was noted for patents admitted during the weekend.
