title: 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.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Pennsylvania trauma system.
  
  
  METHODS
  A total of 90,461 patients over 5 years.
  
  
  METHODS
  Treatment at a level I, II, or III trauma center.
  
  
  METHODS
  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.
authors.affiliation: Department of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. carrb@upenn.edu
authors.forename: Brendan G
authors.initials: BG
authors.lastname: Carr
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Reilly
authors.forename: C William
authors.initials: CW
authors.lastname: Schwab
authors.forename: Charles C
authors.initials: CC
authors.lastname: Branas
authors.forename: Juliet
authors.initials: J
authors.lastname: Geiger
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Wiebe
mesh_terms: D000328:Adult; D000368:Aged; D002940:Circadian Rhythm; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000592:standards*; D010414:Pennsylvania / Q000453:epidemiology; D010561:Personnel Staffing and Scheduling / Q000592:standards*; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D014193:Trauma Centers / Q000706:statistics & numerical data*; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000628:therapy