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

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Kazuaki Shinohara²  Choichiro Tase¹  Ryota Inokuchi³  Yutaka Kawakami²  Yudai Iwasaki²  Tokiya Ishida²  Yuko Ono¹ 

[1] Emergency and Critical Care Medical Center, Fukushima Medical University Hospital, 1 Hikarigaoka, Koriyama, 960-1295, Fukushima, Japan;Emergency and Critical Care Medical Center, Ohta General Hospital Foundation, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, 963-8558, Fukushima, Japan;Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku 113-8655, Tokyo, Japan

关键词: Weekend presentation;    Unexpected trauma death;    Transarterial embolization;    Preoperative period;    Night presentation;    Emergency surgery;    Complications;   

Others  :  1131998
DOI  :  10.1186/s13049-015-0095-1

 received in 2014-08-15, accepted in 2015-01-19,  发布年份 2015

【 摘 要 】

Background

Because 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.

Methods

This 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.

Results

Of 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.

Conclusions

At 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.

【 授权许可】

   
2015 Ono et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

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