Weekend and night outcomes in a statewide trauma system

Abstract

Objective: To evaluate whether mortality and clinical outcomes vary for injured patients in a mature trauma system on weeknights and weekends compared with weekdays.

Design: Retrospective cohort study.

Setting: Pennsylvania trauma system.

Patients: A total of 90,461 patients over 5 years.

Intervention: Treatment at a level I, II, or III trauma center.

Main outcome measures: In-hospital mortality, time to procedures, and length of stay.

Results: In adjusted analyses, patients presenting on weeknights were no more likely to die than patients presenting during weekdays, and patients presenting on weekends were less likely to die than patients presenting on weekdays (odds ratio = 0.89; 95% confidence interval, 0.81-0.97). Presenting on weeknights was associated with longer intensive care unit stay (incidence rate ratio = 1.06; 95% confidence interval, 1.02-1.10) and longer hospital stay (incidence rate ratio = 1.02; 95% confidence interval, 1.00-1.04). Presenting on weekends was associated with longer intensive care unit stay (incidence rate ratio = 1.04; 95% confidence interval, 1.02-1.10) but not longer hospital stay. Delays to laparotomy or craniotomy were not seen in either group.

Conclusions: We demonstrate comparable mortality among injured patients presenting on weeknights vs weekdays and lower mortality among injured patients on weekends vs weekdays. Systems-based solutions of the trauma model are protective against the weekend effect and inform care for other emergency care-sensitive conditions.