title: Office hours vs after-hours. Do presentation times affect the rate of missed injuries in trauma patients?
abstract: BACKGROUND
  A number of studies have investigated the effect of presentation time on the outcome of patients presenting following trauma. However, it is uncertain whether there is a difference in the incidence of missed injuries between patients presenting during 'office hours' to those presenting in the 'after-hours' period.
  
  
  METHODS
  We analysed all patients recorded in the Trauma Registry of Royal Perth Hospital (a Level I Trauma Centre for adults in Western Australia) between 2003 and 2013. Patients were divided into 3 groups i.e. those presenting during office hours, those presenting 'after-hours' on a weekday and those presenting on a weekend. In 2008, the State Major Trauma Unit (SMTU) at RPH was initiated following which in-hospital cover by the Trauma Fellows was extended to 11 PM on weekdays. The study was therefore divided into two time periods i.e. pre-SMTU (2003-2007) and post-SMTU (2008-2013).
  
  
  RESULTS
  53,030 patients were recorded in the Trauma Registry in the 10-year period (major and minor trauma). There were 2519 missed injuries in 1262 patients (2.4%). Of these, 2.2% patients presented during office hours, 2.6% 'after-hours on a weekday' and 2.5% on weekends. The odds of missing an injury were 1.2 times higher if the patient presented after-hours (p=0.048). Missed injury rates were found to have increased over the past 10 years (p=0.0179). The odds of missing an injury in 2013 were 1.34 times higher than in 2003. Most of the missed injuries were AIS 1 and 2 (19.8 and 59%) and 55% had no clinical impact on the patients. Thoracic Spine and abdominal injuries were most commonly missed. The only region to show a significant difference between the 3 groups of patients studied was the abdomen (5.3% vs 11.1% vs 6.3%; p=0.004). It was also seen that a larger number of hollow viscus abdominal injuries (5.2%) were missed when compared to solid organs (3.2%; p<0.001).
  
  
  CONCLUSIONS
  Injuries in patients sustaining trauma are more likely to be missed 'after-hours' than during 'office hours'. T-spine and abdominal injuries are more likely to be missed when compared to other anatomical regions of the body.
authors: State Major Trauma Service, Royal Perth Hospital, Perth, Western Australia, Australia. Electronic address: samiamazahir@hotmail.com.
authors: Samia
authors: S
authors: Mazahir
authors: State Major Trauma Service, Royal Perth Hospital, Perth, Western Australia, Australia.
authors: Amyn
authors: A
authors: Pardhan
authors: State Major Trauma Service, Royal Perth Hospital, Perth, Western Australia, Australia.
authors: Sudhakar
authors: S
authors: Rao
mesh_terms: D000293:Adolescent; D000328:Adult; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis* / Q000453:epidemiology; D012042:Registries / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D014193:Trauma Centers / Q000592:standards / Q000706:statistics & numerical data*; D014904:Western Australia / Q000453:epidemiology
keywords: After-hours admission; Missed injury; Office hours admission; Presentation time; Trauma outcome; Weekend admission