title: Traumatic subdural hematoma: Is there a weekend effect?
abstract: OBJECTIVE
  Traumatic subdural hematoma (TSDH) is a surgical emergency. The effect of weekend admission on surgery and in-hospital outcomes in TSDH is not known.
  
  
  METHODS
  We queried the Nationwide Inpatient Sample from 2002 to 2011 and used ICD-9-CM codes to identify all non-elective admissions with a primary diagnosis of TSDH. We did a subgroup analysis of patients who underwent surgical evacuation. Predictor variables included several patient and hospital characteristics. Outcome variables included length of stay, total hospitalization cost, in-hospital complications, adverse discharge disposition, and in-hospital mortality. We used multivariable analysis to determine if weekend admission was independently associated with increased likelihood of poor outcomes.
  
  
  RESULTS
  Out of a total of 404,212 TSDH admissions, 24.8% received surgical intervention. Patients admitted on weekends were less likely to undergo surgical intervention (odds ratio [OR]: 0.85). In the surgical cohort, weekend admissions consisted of more patients with prolonged loss of consciousness (24+h) without return to baseline (7.0% vs. 4.8%). In all TSDH patients and in sub-group of surgical cohort, weekend admission was associated with an increased likelihood of in-hospital complication (OR: 1.06 and 1.12), prolonged length of stay (OR: 1.08 and 1.17), increased total hospital costs (OR: 1.04 and 1.11), adverse discharge (OR: 1.08 and 1.18), and in-hospital mortality (OR: 1.04 and 1.11). All p-values were less than 0.01.
  
  
  CONCLUSIONS
  Our study demonstrates that patients admitted on weekends had similar mortality despite higher severity with no clinically significant weekend effect for tSDH.
authors.affiliation: University of Missouri-Kansas City, School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, USA. Electronic address: kr899@mail.umkc.edu.
authors.forename: Kavelin
authors.initials: K
authors.lastname: Rumalla
authors.affiliation: University of Missouri-Kansas City, School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, USA. Electronic address: ar2dc@mail.umkc.edu.
authors.forename: Adithi Y
authors.initials: AY
authors.lastname: Reddy
authors.affiliation: University of Kansas Medical Center, Department of Neurology MS 2012, 3599 Rainbow Blvd, Kansas City, KS 66160, USA. Electronic address: mmittal2@kumc.edu.
authors.forename: Manoj K
authors.initials: MK
authors.lastname: Mittal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006408:Hematoma, Subdural / Q000453:epidemiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data*; D013997:Time Factors; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Mortality; Nationwide inpatient sample; Outcomes; Subdural hematoma; Surgical intervention; Weekend effect