Mortality rates following trauma: The difference is night and day

Abstract

Background:Although most medical centers are equipped for 24-h care, some “middle of the night” services may not be as robust as they are during daylight hours. This would have potential impact upon certain outcome measurements in trauma patients. The purpose of this paper was to assess the effect of patient arrival time at hospital emergency departments on in-hospital survival following trauma.Materials and Methods:Data of patients, 18 years of age or older, with no evidence that they were transferred to or from that center were obtained from the National Trauma Data Bank Version 7.0. Patients meeting the above criteria were excluded if there was no valid mortality status, arrival time information, injury severity score, or trauma center designation. The primary analyses investigated the association of arrival time and trauma center level on mortality. Relative risks of mortality versus patient arrival time and trauma level were determined after controlling for age, gender, race, comorbidities, injury, region of the country, and year of admission.Results:In total, 601,388 or 71.7% of the 838,284 eligible patients were retained. The overall in-hospital mortality rate was 4.7%. The 6 p.m. to 6 a.m. time period had a significantly higher adjusted relative risk for in-hospital mortality than the 6 a.m. to 6 p.m. time frame (ARR=1.18, P<;0.0001). This pattern held across trauma center levels, but was the weakest at Level I and the strongest at Level III/IV centers (Level I: ARR=1.10, Level II: ARR=1.14, and combined Level III/IV: ARR=1.32, all P<0.0001).Conclusion:Hospital arrival between midnight and 6 a.m. was associated with a higher mortality rate than other times of the day. This relationship held true across all trauma center levels. This information may warrant a redistribution of hospital resources across all time periods of the day.

The association between hospital arrival time, transport method, prehospital time intervals, and in-hospital mortality in trauma patients presenting to Khayelitsha Hospital, Cape Town

“…These results should be interpreted with caution due to low mortality events (n = 18) and the large patient influx on Sundays. We still hypothesise that the arrival day and time could have an impact on mortality, although the effect is still unclear [7] , [10] .…”

“…The arrival time of trauma patients might also play a role in the mortality rate. Patients arriving during the early morning hours tend to have a higher mortality compared to other times [10] . However, this theory has been challenged by studies indicating that time of arrival had no influence on the risk for adverse outcomes [7] , [11] .…”

Epidemiology of injuries seen in a nigerian tertiary hospital

“…This is comparable to 2% and 4.4% reported by Thanni and Kehinde [ 12 ] and Solagberu et al ., [ 19 ] respectively, in Nigeria and 4.7% by Egol et al . [ 26 ] in USA. TBI was the most common cause of death and this is similar to reports from other studies.…”

Risk factors of mortality in nosocomial infected traumatic patients in a trauma referral center in south of Iran

“…According to the center for disease control (CDC), trauma-related injuries remain a leading cause of death in the United States each year. 1 In the United States, there were at least 1.7 million nosocomial infections yearly with the annual cost of $9.8 billions. 2 Iran, as a developing country with a population of 73 million, is also faced with a high incidence of injury-related mortality and morbidity.…”