title: The weekend effect for patients with sepsis presenting to the emergency department.
abstract: BACKGROUND
  Mortality differences in weekend and weekday admissions have been observed for a variety of conditions that require aggressive early intervention. It is unknown if there is a mortality difference that exists for patients presenting to the Emergency Department (ED) with sepsis on the weekend.
  
  
  OBJECTIVE
  We hypothesized that there is an increase in early inpatient mortality (death on day 1 or day 2 of hospitalization) among patients with sepsis who present to the ED on the weekend vs. weekdays.
  
  
  METHODS
  We performed a cross-sectional analysis of 114,611 ED admissions with a principal diagnosis consistent with sepsis from 576 hospitals in the 2008 Nationwide Inpatient Sample. Adjusted analyses controlled for patient and hospital characteristics, and examined the likelihood of either early (day 1 or day 2 of hospitalization) or overall inpatient mortality.
  
  
  RESULTS
  A greater proportion of patients admitted on the weekend died on day 1 and day 2 of hospitalization (5.4% vs. 4.0%, p < 0.001; and 7.5% vs. 6.9%, p = 0.001), the difference for overall inpatient mortality was not significant (17.9% vs. 17.5%, p = 0.08). The risk-adjusted odds ratio (OR) of day 1 and day 2 early inpatient mortality of weekend vs. weekday admissions was 1.10 (95% confidence interval [CI] 1.04-1.17) and 1.08 (95% CI 1.03-1.14), respectively; the association with overall inpatient mortality was not significant (OR 1.03, 95% CI 1.00-1.07).
  
  
  CONCLUSIONS
  Patients admitted through the ED with sepsis on the weekend had a greater likelihood of early mortality, but not overall mortality, when compared to patients admitted on weekdays.
authors.affiliation: Department of Emergency Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Institute for Healthcare Studies and Division of General Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Emilie S
authors.initials: ES
authors.lastname: Powell
authors.forename: Rahul K
authors.initials: RK
authors.lastname: Khare
authors.forename: D Mark
authors.initials: DM
authors.lastname: Courtney
authors.forename: Joe
authors.initials: J
authors.lastname: Feinglass
mesh_terms: D000293:Adolescent; D000328:Adult; D039602:After-Hours Care / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000401:mortality*; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: health services research; mortality; outcome assessment; sepsis