Nocturnal violence: implications for resident trauma operative experiences.
Trauma centers face novel challenges in resource allocation in an era of cost consciousness and work-hour restrictions. Studies have shown that time of day and day of week affect trauma admission volume; however, these studies were performed in cold climates. Data from 2000 to 2010  at a Level I trauma center were reviewed. Demographic, injury severity, and injury timing from 23,827 trauma patients were analyzed along with their emergency department disposition (operating room, intensive care unit, ward) and final outcome. Nighttime arrivals (NAs) accounted for 56.6 per  cent and daytime arrivals accounted for 43.4 per cent of total admissions. The increase in NAs was most pronounced during the period from midnight to 6 am on weekends (P < 0.05). Also, the period from midnight to 6 am on weekends showed a significantly increased proportion of penetrating  trauma (P < 0.01). Similarly, there was an increased rate of trauma arrivals needing emergent operative intervention in the period between midnight and 6 am on weekends when compared with any other time period (P < 0.01). In a southern Level I trauma center, patient volume  varies nonrandomly with time. Emergent operative intervention is more likely between midnight and 6 am, the peak time for penetrating trauma. Because resident operative experience is maximized at night and on weekends, coverage during these periods should remain a priority for residency programs.
Department of Surgery, Emory University, Atlanta, Georgia, USA.
Colyn J
CJ
Watkins
Paul L
PL
Feingold
Barry
B
Hashimoto
Laura S
LS
Johnson
Christopher J
CJ
Dente
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D005260:Female; D005500:Follow-Up Studies; D005845:Georgia; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D009551:Night Care / Q000592:standards*; D019637:Orthopedic Procedures / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014754:Violence / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000601:surgery*; D055815:Young Adult