The effect of working hours on outcome from major trauma.
OBJECTIVE
To determine whether being admitted with major trauma to an emergency department outside rather than within working hours results in an adverse outcome.


METHODS
The data were collected from hospitals in England and Wales participating in the Trauma Audit and Research Network (TARN). Data from the TARN database were used. Admission time and discharge status were cross matched, and this was repeated while controlling for Injury Severity Score (ISS) values. Logistic regression was carried out, calculating the effects of Revised Trauma Score (RTS), ISS, age, and time of admission on outcome from major trauma. This allowed observed versus expected mortality rates (Ws) scores to be compared within and outside working hours. As much of the RTS data were missing, this was repeated using the Glasgow Coma Score instead of RTS.


RESULTS
In total, 5.2% of people admitted "out of hours" died, compared with 5.3% of people within working hours, and 12.2% of people admitted outside working hours had an ISS score greater than 15, compared with 10.1% admitted within working hours. Outcome in cases with comparable ISS values were very similar (31.1% of cases with ISS >15 died out of hours, compared with 33.5% inside working hours.) The subgroup of data with missing RTS values had a significantly increased risk of death. Therefore, GCS was used to calculate severity adjusted odds of death instead of RTS. However, with either model, Ws scores were identical (both 0%) within and outside working hours.


CONCLUSIONS
Out of hours admission does not in itself have an adverse effect on outcome from major trauma.
Derriford Hospital, Plymouth, Cornwall, UK. henry.guly@phnt.swest.nhs.uk
H R
HR
Guly
G
G
Leighton
M
M
Woodford
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O
Bouamra
F
F
Lecky
D000293:Adolescent; D000328:Adult; D039602:After-Hours Care / Q000592:standards*; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000592:standards*; D004739:England / Q000453:epidemiology; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008875:Middle Aged; D011379:Prognosis; D016896:Treatment Outcome; D014852:Wales / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*