Management of polytrauma patients in the UK: Is there a 'weekend effect'?
OBJECTIVE
It has been suggested that hospital admission during weekends poses a risk for adverse outcomes and increased patient mortality, the so-called 'weekend effect'. We undertook an evaluation of the impact of weekend admissions to the management of polytraumatised patients, in a Level I Major Trauma Centre (MTC) in the UK.


METHODS
A retrospective review of prospectively documented data of polytrauma patients (injury severity score (ISS)>15), admitted between April 2013 and August 2015 was performed. Exclusion criteria included patients initially assessed in other institutions. All patients were initially managed at the emergency department (ED) according to ATLS®principles and underwent a trauma computed tomography (CT) scan, unless requiring immediate surgical intervention.


RESULTS
During the study period 1735 patients (pts) were admitted under the care of the MTC. Four hundred and five pts were excluded as they were transferred from other institutions and 300 pts were excluded as their ISS was less than 16. Overall 1030 patients met the inclusion criteria, out of which 731 were males. Comparing the two groups (Group A: weekday admissions (670), Group B: weekend admissions (360)), there was no difference in pts gender, mechanism of injury, GCS at presentation, need for intubation and time to CT. Patients admitted over the weekend were younger (p<0.01) and presented with haemodynamic instability more frequently (p=0.02). Time to operating room was also lower during the weekend, but this did not reach statistical significance (p=0.08). Mortality was lower in Group B: 39/360 pts (10.8%) compared to Group A: 100/670 pts (14.9%) (p=0.07). The relative risk (RR) of weekend mortality was calculated as 0.726 (95% CI: 0.513-1.027).


CONCLUSIONS
Weekend polytrauma patients appear to be younger, more severely injured and present with a higher incidence of haemodynamic instability (shock). Overall, we failed to identify a "weekend effect" in relation to mortality, time to CT and time to operating room. On the contrary, a lower risk of mortality was noted for patents admitted during the weekend.
Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, UK.
Vasileios
V
Giannoudis
Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, UK; NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, LS7 4SA Leeds, West Yorkshire, UK.
Michalis
M
Panteli
Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, UK; NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, LS7 4SA Leeds, West Yorkshire, UK. Electronic address: p.giannoudis@leeds.ac.uk.
Peter V
PV
Giannoudis
D000328:Adult; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality* / Q000628:therapy; D010343:Patient Admission; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014193:Trauma Centers; D006113:United Kingdom
CT scan; Mortality; Polytrauma; Shock; Weekend effect