Laupland Kevin B, Ball Chad G, Kirkpatrick Andrew W
Department of Medicine, University of Calgary and Calgary Health Region, Calgary, Alberta, Canada.
J Trauma Manag Outcomes. 2009 Jul 27;3:8. doi: 10.1186/1752-2897-3-8.
Patient care may be inconsistent during off hours. We sought to determine whether victims of major trauma admitted to hospital on evenings, nights, and weekends suffer increased mortality rates. All victims of major trauma admitted to all four major acute care hospitals in the Calgary Health Region between April 1, 2002 and March 31, 2006 were included. Clinical and outcome information was obtained from regional databases. Weekends were defined as anytime Saturday or Sunday, evenings as 18:00-22:59, and nights as 23:00-07:59.
Four thousand patients were included; 2,901 (73%) were male, the median age was 39.5 [inter-quartile range (IQR), 22.4-58.2] years, and the median injury severity score (ISS) was 20 (IQR, 16-26). Thirty-five percent (1,405) of patients were admitted on a weekend, 30% (1,197) during evenings, and 36% (1,422) at night. Seventy-eight percent (3,106) of cases presented during the "after hours" (evenings, nights, and/or weekends). The in-hospital case-fatality rate was 447 (11%), and was not significantly different during daytime (165/1,381; 37%), evening (128/1,197; 30%), and night (154/1,422; 36%) admissions (p = 0.53), or among patients admitted on weekends as compared to weekdays (157/1,405; 11% vs. 290/2,595; 11%; p = 1.0). Admission during the after hours as compared to business hours (343/3,106; 11% vs. 104/894; 12%; p = 0.63) did not increased risk. A multivariable logistic regression model was developed to assess factors associated with in-hospital death (n = 3,891). Neither admission on weekends nor on evenings or nights increased the risk for in-hospital mortality.
In our region, the time of admission during the day or day of the week does not influence the risk for adverse outcome and may reflect our highly developed multi-hospital acute care and trauma system.
非工作时间的患者护理可能存在不一致的情况。我们试图确定在晚上、夜间和周末入院的严重创伤患者死亡率是否会增加。纳入了2002年4月1日至2006年3月31日期间在卡尔加里健康区的所有四家主要急症医院收治的所有严重创伤患者。临床和结局信息从区域数据库中获取。周末定义为周六或周日的任何时间，晚上为18:00 - 22:59，夜间为23:00 - 07:59。
共纳入4000例患者；其中2901例（73%）为男性，年龄中位数为39.5岁[四分位间距（IQR），22.4 - 58.2岁]，损伤严重程度评分（ISS）中位数为20（IQR，16 - 26）。35%（1405例）患者在周末入院，30%（1197例）在晚上入院，36%（1422例）在夜间入院。78%（3106例）的病例在“非工作时间”（晚上、夜间和/或周末）就诊。院内病死率为447例（11%），白天（165/1381；37%）、晚上（128/1197；30%）和夜间（154/1422；36%）入院时的病死率无显著差异（p = 0.53），周末入院患者与工作日入院患者相比（157/1405；11%对290/2595；11%；p = 1.0）也无显著差异。与工作时间相比，非工作时间入院（343/3106；11%对104/894；12%；p = 0.63）并未增加风险。建立了多变量逻辑回归模型来评估与院内死亡相关的因素（n = 3891）。周末、晚上或夜间入院均未增加院内死亡风险。
在我们地区，一天中的入院时间或一周中的日期并不影响不良结局的风险，这可能反映了我们高度发达的多医院急症护理和创伤系统。
