A population based study on the night-time effect in trauma care

Bartolomeo, Stefano Di; Marino, Massimiliano; Ventura, Chiara; Trombetti, Susanna; Palma, Rossana De

doi:10.1136/emermed-2013-202338

Cited by 12 publications

(8 citation statements)

References 24 publications

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“…Therefore, the care of injured patients requiring emergency trauma surgery is extremely time sensitive. Di Bartolomeo et al [ 43 ] recently studied patients transferred with severe injuries and found that patients who were not brought directly to a level I trauma center were more likely to be affected by the off-hour effect. Di Bartolomeo suggested that the off-hour effect in trauma care could be used as a quality indicator [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

The off-hour effect on trauma patients requiring subspecialty intervention at a community hospital in Japan: a retrospective cohort study

Ono

Ishida

Iwasaki

et al. 2015

Scand J Trauma Resusc Emerg Med

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BackgroundBecause most community hospitals in Japan do not maintain 24-h availability of in-house anesthesiologists, surgeons, and interventional radiologists, staffing dramatically declines during off hours. It is unclear whether, in such under-resourced hospitals, trauma patients presenting during off hours and requiring subspecialty intervention have worse outcomes than those who present during business hours.MethodsThis was a retrospective cohort study at a community hospital in Japan. Participants were all injured patients requiring emergency trauma surgery or transarterial embolization who presented from January 2002 to December 2013. We investigated whether outcomes of these patients differed between business hours (8:01 AM to 6:00 PM weekdays) and off hours (6:01 PM to 8:00 AM weekdays plus all weekend hours). The primary outcome measure was mortality rate, and the secondary outcome measures were duration of emergency room (ER) stay; unexpected death (death/probability of survival > 0.5); and adverse events occurring in the ER. We adjusted for potential confounders of age, sex, Injury Severity Score (ISS), Revised Trauma Score, presentation phase (2002–2005, 2006–2009, and 2010–2013), Charlson Comorbidity Index, and injury type (blunt or penetrating) using logistic regression models.ResultsOf the 805 patients included, 379 (47.1%) presented during business hours and 426 (52.9%) during off hours. Off-hours presentation was associated with longer ER stays for patients with systolic blood pressure < 90 mmHg on admission (p = 0.021), ISS >15 (p = 0.047), and pelvic fracture requiring transarterial embolization (p < 0.001). Off-hours presentation was also associated with increased risk of adverse events in the ER (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.1–2.7, p = 0.020). After adjustment for confounders, an increased risk of adverse events (OR 1.6, 95% CI 1.1–2.7, p = 0.049) persisted, but no differences were detected in mortality (p = 0.80) and unexpected death (p = 0.44) between off hours and business hours.ConclusionsAt a community hospital in Japan, presentation during off hours was associated with a longer ER stay for severely injured patients and increased risk of adverse events in the ER. However, these disadvantages did not impact mortality or unexpected outcome.

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Section: Discussionmentioning

confidence: 99%

The off-hour effect on trauma patients requiring subspecialty intervention at a community hospital in Japan: a retrospective cohort study

Ono

Ishida

Iwasaki

et al. 2015

Scand J Trauma Resusc Emerg Med

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“…Some studies show that this factor does not have an aggravating effect, 7 , 8 , 9 , 10 while others show that it has a negative influence. 11 , 12 , 13…”

Section: Introductionmentioning

confidence: 99%

Why do some trauma patients die while others survive? A matched-pair analysis based on data from Trauma Register DGU®

Bieler

Paffrath

Schmidt

et al. 2020

Chinese Journal of Traumatology

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Purpose The mortality rate for severely injured patients with the injury severity score (ISS) ≥16 has decreased in Germany. There is robust evidence that mortality is influenced not only by the acute trauma itself but also by physical health, age and sex. The aim of this study was to identify other possible influences on the mortality of severely injured patients. Methods In a matched-pair analysis of data from Trauma Register DGU®, non-surviving patients from Germany between 2009 and 2014 with an ISS≥16 were compared with surviving matching partners. Matching was performed on the basis of age, sex, physical health, injury pattern, trauma mechanism, conscious state at the scene of the accident based on the Glasgow coma scale, and the presence of shock on arrival at the emergency room. Results We matched two homogeneous groups, each of which consisted of 657 patients (535 male, average age 37 years). There was no significant difference in the vital parameters at the scene of the accident, the length of the pre-hospital phase, the type of transport (ground or air), pre-hospital fluid management and amounts, ISS, initial care level, the length of the emergency room stay, the care received at night or from on-call personnel during the weekend, the use of abdominal sonographic imaging, the type of X-ray imaging used, and the percentage of patients who developed sepsis. We found a significant difference in the new injury severity score, the frequency of multi-organ failure, hemoglobine at admission, base excess and international normalized ratio in the emergency room, the type of accident (fall or road traffic accident), the pre-hospital intubation rate, reanimation, in-hospital fluid management, the frequency of transfusion, tomography (whole-body computed tomography), and the necessity of emergency intervention. Conclusion Previously postulated factors such as the level of care and the length of the emergency room stay did not appear to have a significant influence in this study. Further studies should be conducted to analyse the identified factors with a view to optimising the treatment of severely injured patients. Our study shows that there are significant factors that can predict or influence the mortality of severely injured patients.

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“…In contrast, Di Bartolomeo et al could demonstrate an off hour effect on trauma patients. This effect was most evident in transferred cases [37]. In other medical emergencies, like stroke [38][39][40][41] or myocardial infarction [42,43] previous studies didn't come to a consistent conclusion regarding the impact of the hospital admission time on the outcome.…”

Section: Discussionmentioning

confidence: 87%

Trauma care inside and outside business hours: comparison of process quality and outcome indicators in a German level-1 trauma center

Parsch

Loibl

Schmucker

et al. 2014

Scand J Trauma Resusc Emerg Med

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A population based study on the night-time effect in trauma care

Cited by 12 publications

References 24 publications

The off-hour effect on trauma patients requiring subspecialty intervention at a community hospital in Japan: a retrospective cohort study

The off-hour effect on trauma patients requiring subspecialty intervention at a community hospital in Japan: a retrospective cohort study

Why do some trauma patients die while others survive? A matched-pair analysis based on data from Trauma Register DGU®

Trauma care inside and outside business hours: comparison of process quality and outcome indicators in a German level-1 trauma center

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