Patients treated on weekends for trauma injuries may have a greater chance of survival

Patients suffering from trauma injuries are more likely to survive if they arrive at the hospital during the weekend rather than a weekday, according to a study published online in the Archives of Surgery.

University of Pennsylvania School of Medicine investigators also found that trauma patients who present to the hospital on weeknights are no more likely to die than those who present during the day. The findings contrast previous studies showing a “weekend effect” in which patients with emergent illnesses, such as heart attacks and strokes, fare worse when hospitalized at night or during the weekend, according to a press release.

“Whether patients have an emergent illness or a severe injury, the common denominator is time,” lead author Brendan G. Carr, MD, MS, stated in the release. “Trauma systems have been designed to maximize rapid access to trauma care, and our results show that the system also offers special protection for patients injured during periods that are known to be connected to worse outcomes among patients with time-sensitive illnesses.”

Study methods and findings

Using data provided by the Pennsylvania Trauma Systems Foundation, the investigators performed a retrospective cohort study which included 90,461 patients who were treated at a level I, II, or III trauma center between 2004 and 2008. Main outcome measures of the study included in-hospital mortality, time to procedure and length of stay.

About a quarter of the patients reviewed in the study presented to the hospital on weeknights – defined as 6 p.m. to 9 a.m. Monday through Friday – and about 40% arrived on the weekend, which was defined as 6 p.m. Friday to 9 a.m. Monday.

Results of adjusted analyses showed that patients who presented on weeknights were no more likely to die than those who presented during weekdays. Those presenting on weekends were found less likely to die than patients presenting on weekdays. However, presentation on a weeknight was associated with longer intensive care unit and hospital stays. Presenting on the weekend was also found to be associated with a longer intensive care unit stay, but not a longer hospital stay.

In addition, the investigators found that neither weekend nor nighttime patient groups experienced delays for laparotomy or craniotomy.

What trauma care can teach us

According to the study authors, the organization and staffing of the trauma system appears to serve as a built-in protection for critically-injured patients. Furthermore, they noted, these organization and staffing protocols may provide a roadmap for ongoing efforts to restructure and better coordinate emergency care. Trauma centers, such as the Hospital of the University of Pennsylvania, are required to have proper staffing and resources immediately available at all times, rather than varying availability based upon day and time.

“There are complex questions that need to be addressed about our expectations round emergency care,” Carr stated in the release. “It is unrealistic to think that all hospitals can be fully staffed to provide optimal care for all time-sensitive conditions all of the time, so our challenge is to develop an integrated system of emergency care for unplanned – but inevitable – critical illness. The trauma system has a plan of care in place long before we ever need it, and it offers many lessons for the remainder of emergency care.”

Reference:
Carr BG, et al. Weekend and night outcomes in a statewide trauma system. Arch Surg. Published online March 21, 2011. doi:10.1001/archsurg.2011.60
Disclosure: The authors have reported no relevant financial disclosures.

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