The Off-hour Effect on Trauma Patients Requiring Subspecialty Intervention at a Community Hospital in Japan: a Retrospective Cohort Study

Overview

Journal Scand J Trauma Resusc Emerg Med

Publisher Biomed Central

Specialty Emergency Medicine

Date 2015 Apr 18

PMID 25882601

Citations 15

Authors

Yuko Ono

Tokiya Ishida

Yudai Iwasaki

Yutaka Kawakami

Ryota Inokuchi

Choichiro Tase

Kazuaki Shinohara

Affiliations

Soon will be listed here.

Abstract

Background: Because most community hospitals in Japan do not maintain 24-h availability of in-house anesthesiologists, surgeons, and interventional radiologists, staffing dramatically declines during off hours. It is unclear whether, in such under-resourced hospitals, trauma patients presenting during off hours and requiring subspecialty intervention have worse outcomes than those who present during business hours.

Methods: This was a retrospective cohort study at a community hospital in Japan. Participants were all injured patients requiring emergency trauma surgery or transarterial embolization who presented from January 2002 to December 2013. We investigated whether outcomes of these patients differed between business hours (8:01 AM to 6:00 PM weekdays) and off hours (6:01 PM to 8:00 AM weekdays plus all weekend hours). The primary outcome measure was mortality rate, and the secondary outcome measures were duration of emergency room (ER) stay; unexpected death (death/probability of survival > 0.5); and adverse events occurring in the ER. We adjusted for potential confounders of age, sex, Injury Severity Score (ISS), Revised Trauma Score, presentation phase (2002-2005, 2006-2009, and 2010-2013), Charlson Comorbidity Index, and injury type (blunt or penetrating) using logistic regression models.

Results: Of the 805 patients included, 379 (47.1%) presented during business hours and 426 (52.9%) during off hours. Off-hours presentation was associated with longer ER stays for patients with systolic blood pressure < 90 mmHg on admission (p = 0.021), ISS >15 (p = 0.047), and pelvic fracture requiring transarterial embolization (p < 0.001). Off-hours presentation was also associated with increased risk of adverse events in the ER (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.1-2.7, p = 0.020). After adjustment for confounders, an increased risk of adverse events (OR 1.6, 95% CI 1.1-2.7, p = 0.049) persisted, but no differences were detected in mortality (p = 0.80) and unexpected death (p = 0.44) between off hours and business hours.

Conclusions: At a community hospital in Japan, presentation during off hours was associated with a longer ER stay for severely injured patients and increased risk of adverse events in the ER. However, these disadvantages did not impact mortality or unexpected outcome.

Citing Articles

Comparison of survival outcomes and anatomically specific severe injuries following traffic accidents among occupants of standard and K-car vehicles: A retrospective cohort study at a teaching hospital in Japan.

Ono Y, Uzawa T, Sugiyama J, Tomita N, Kakamu T, Ishida T PLoS One. 2025; 20(2):e0318748.

PMID: 39908305 PMC: 11798441. DOI: 10.1371/journal.pone.0318748.

Survival status and its predictors among adult victims of road traffic accident admitted to public hospitals of Bahir Bar City, Amhara regional state, Northwest, Ethiopia, 2023: multi center retrospective follow-up study.

Kebede A, Tegenaw A, Tamir Y, Afewerk S, Belayneh A, Tamre S BMC Emerg Med. 2024; 24(1):177.

PMID: 39350027 PMC: 11443762. DOI: 10.1186/s12873-024-01093-9.

Angioembolization in patients with blunt splenic trauma in Germany -guidelines vs. Reality a retrospective registry-based cohort study of the TraumaRegister DGU®.

Kolbel B, Imach S, Engelhardt M, Wafaisade A, Lefering R, Beltzer C Eur J Trauma Emerg Surg. 2024; 50(5):2451-2462.

PMID: 39283492 PMC: 11599407. DOI: 10.1007/s00068-024-02640-6.

Attempted Suicide Is Independently Associated with Increased In-Hospital Mortality and Hospital Length of Stay among Injured Patients at Community Tertiary Hospital in Japan: A Retrospective Study with Propensity Score Matching Analysis.

Ono Y, Ishida T, Tomita N, Takayama K, Kakamu T, Kotani J Int J Environ Res Public Health. 2024; 21(2).

PMID: 38397612 PMC: 10888049. DOI: 10.3390/ijerph21020121.

Variation in the utilization of angioembolization for splenic injury in hospitals: a nationwide cross-sectional study in Japan.

Aoki M, Abe T, Hagiwara S, Saitoh D Acute Med Surg. 2023; 10(1):e837.

PMID: 37064787 PMC: 10097635. DOI: 10.1002/ams2.837.

References

Feero S, Hedges J, Simmons E, Irwin L . Does out-of-hospital EMS time affect trauma survival?. Am J Emerg Med. 1995; 13(2):133-5. DOI: 10.1016/0735-6757(95)90078-0. View

McKee M, Black N . Does the current use of junior doctors in the United Kingdom affect the quality of medical care?. Soc Sci Med. 1992; 34(5):549-58. DOI: 10.1016/0277-9536(92)90210-h. View

Hendey G, Barth B, Soliz T . Overnight and postcall errors in medication orders. Acad Emerg Med. 2005; 12(7):629-34. DOI: 10.1197/j.aem.2005.02.009. View

Arbabi S, Jurkovich G, Wahl W, Kim H, Maier R . Effect of patient load on trauma outcomes in a Level I trauma center. J Trauma. 2005; 59(4):815-8. DOI: 10.1097/01.ta.0000188390.80199.37. View

Gonzalez R, Cummings G, Mulekar M, Rodning C . Increased mortality in rural vehicular trauma: identifying contributing factors through data linkage. J Trauma. 2006; 61(2):404-9. DOI: 10.1097/01.ta.0000229816.16305.94. View

Angele M, Frantz M, Chaudry I . Gender and sex hormones influence the response to trauma and sepsis: potential therapeutic approaches. Clinics (Sao Paulo). 2006; 61(5):479-88. DOI: 10.1590/s1807-59322006000500017. View

Kostis W, Demissie K, Marcella S, Shao Y, Wilson A, Moreyra A . Weekend versus weekday admission and mortality from myocardial infarction. N Engl J Med. 2007; 356(11):1099-109. DOI: 10.1056/NEJMoa063355. View

Saposnik G, Baibergenova A, Bayer N, Hachinski V . Weekends: a dangerous time for having a stroke?. Stroke. 2007; 38(4):1211-5. DOI: 10.1161/01.STR.0000259622.78616.ea. View

Bendavid E, Kaganova Y, Needleman J, Gruenberg L, Weissman J . Complication rates on weekends and weekdays in US hospitals. Am J Med. 2007; 120(5):422-8. DOI: 10.1016/j.amjmed.2006.05.067. View

10.

Peberdy M, Ornato J, Larkin G, Braithwaite R, Kashner T, Carey S . Survival from in-hospital cardiac arrest during nights and weekends. JAMA. 2008; 299(7):785-92. DOI: 10.1001/jama.299.7.785. View

11.

Sperry J, Nathens A, Frankel H, Vanek S, Moore E, Maier R . Characterization of the gender dimorphism after injury and hemorrhagic shock: are hormonal differences responsible?. Crit Care Med. 2008; 36(6):1838-45. DOI: 10.1097/CCM.0b013e3181760c14. View

12.

Johnson J . The increased incidence of anesthetic adverse events in late afternoon surgeries. AORN J. 2008; 88(1):79-87. DOI: 10.1016/j.aorn.2008.02.020. View

13.

de Knegt C, Meylaerts S, Leenen L . Applicability of the trimodal distribution of trauma deaths in a Level I trauma centre in the Netherlands with a population of mainly blunt trauma. Injury. 2008; 39(9):993-1000. DOI: 10.1016/j.injury.2008.03.033. View

14.

Boyd C, Tolson M, Copes W . Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987; 27(4):370-8. View

15.

Champion H, Sacco W, Copes W, GANN D, Gennarelli T, Flanagan M . A revision of the Trauma Score. J Trauma. 1989; 29(5):623-9. DOI: 10.1097/00005373-198905000-00017. View

16.

Thorpe K . House staff supervision and working hours. Implications of regulatory change in New York State. JAMA. 1990; 263(23):3177-81. View

17.

Champion H, Copes W, Sacco W, Lawnick M, Keast S, Bain Jr L . The Major Trauma Outcome Study: establishing national norms for trauma care. J Trauma. 1990; 30(11):1356-65. View

18.

Thompson C, Bickell W, Siemens R, Sacra J . Community hospital level II trauma center outcome. J Trauma. 1992; 32(3):336-41; discussion 341-3. DOI: 10.1097/00005373-199203000-00011. View

19.

Barone J, Ryan M, Cayten C, Murphy J . Is 24-hour operating room staff absolutely necessary for level II trauma center designation?. J Trauma. 1993; 34(6):878-82; discussion 882-3. DOI: 10.1097/00005373-199306000-00020. View

20.

Moore L, Lavoie A, Le Sage N, Bergeron E, Emond M, Liberman M . Using information on preexisting conditions to predict mortality from traumatic injury. Ann Emerg Med. 2008; 52(4):356-364.e2. DOI: 10.1016/j.annemergmed.2007.09.007. View