Hospital mortality among major trauma victims admitted on weekends and evenings: a cohort study

Four thousand patients were included; 2,901 (73%) were male, the median age was 39.5 [inter-quartile range (IQR), 22.4–58.2] years, and the median injury severity score (ISS) was 20 (IQR, 16–26). Thirty-five percent (1,405) of patients were admitted on a weekend, 30% (1,197) during evenings, and 36% (1,422) at night. Seventy-eight percent (3,106) of cases presented during the "after hours" (evenings, nights, and/or weekends). The in-hospital case-fatality rate was 447 (11%), and was not significantly different during daytime (165/1,381; 37%), evening (128/1,197; 30%), and night (154/1,422; 36%) admissions (p = 0.53), or among patients admitted on weekends as compared to weekdays (157/1,405; 11% vs. 290/2,595; 11%; p = 1.0). Admission during the after hours as compared to business hours (343/3,106; 11% vs. 104/894; 12%; p = 0.63) did not increased risk. A multivariable logistic regression model was developed to assess factors associated with in-hospital death (n = 3,891). Neither admission on weekends nor on evenings or nights increased the risk for in-hospital mortality.In our region, the time of admission during the day or day of the week does not influence the risk for adverse outcome and may reflect our highly developed multi-hospital acute care and trauma system.Several studies conducted in a number of different medical, surgical, and critically ill populations have indicated that patients admitted to hospitals on weekends and evenings may suffer a higher mortality rate [1-14]. Many processes of care have been proposed to explain these observations including lower levels of staffing and restricted availability of tests and procedures during these times. In addition, physicans performance may be impaired due to shift work and fatigue during excessive work shifts or work during off-peak vigilant times [15-17]. It is also important to note that patients admitted during "after hours" may be intrinsically at higher risk for death by virtue of a different case-mix or