School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Intern Med J. 2010 Nov;40(11):777-83. doi: 10.1111/j.1445-5994.2009.02067.x.
To determine whether in-hospital deaths of patients admitted through emergency departments with acute exacerbations of chronic obstructive pulmonary disease (COPD), acute myocardial infarction, intracerebral haemorrhage and acute hip fracture are increased by weekend versus weekday admission (the 'weekend effect').
We performed a retrospective analysis of statewide administrative data from public hospitals in Queensland, Australia, during the 2002/2003-2006/2007 financial years. The primary outcome was 30-day in-hospital mortality. The secondary outcome of 2-day in-hospital mortality helped determine whether increased mortality of weekend admissions was closely linked to weekend medical care.
During the study period, there were 30 522 COPD, 17 910 acute myocardial infarction, 4183 acute hip fracture and 1781 intracerebral haemorrhage admissions. There was no significant weekend effect on 30-day in-hospital mortality for COPD (adjusted risk ratio = 0.92, 95% CI: 0.81-1.04, P= 0.222), intracerebral haemorrhage (adjusted risk ratio = 1.01, 95% CI: 0.86-1.16, P= 0.935) or acute hip fracture (adjusted risk ratio = 0.78, 95% CI: 0.54-1.03, P= 0.13). There was a significant weekend effect for acute myocardial infarction (adjusted risk ratio = 1.15, 95% CI: 1.03-1.26, P= 0.007). Two-day in-hospital mortality showed similar results.
This is the first Australian study on the 'weekend effect' (in a cohort other than neonates), and the first study worldwide to assess specifically the weekend effect among COPD patients. Observed patterns were consistent with overseas research. There was a significant weekend effect for myocardial infarction. Further research is needed to determine whether location (e.g. rural), clinical (e.g. disease severity) and service provision factors (e.g. access to invasive procedures) influence the weekend effect for acute medical conditions in Australia.
确定因慢性阻塞性肺疾病（COPD）、急性心肌梗死、脑出血和急性髋部骨折等疾病在急诊科急性加重而住院的患者，其在周末入院与在平日入院相比，院内死亡率是否更高（即“周末效应”）。
我们对澳大利亚昆士兰州公立医院在 2002/2003 至 2006/2007 财政年度的全州行政数据进行了回顾性分析。主要结局指标为 30 天院内死亡率。次要结局指标为 2 天院内死亡率，有助于确定周末入院死亡率增加是否与周末医疗服务密切相关。
在研究期间，COPD 患者有 30522 人，急性心肌梗死患者有 17910 人，急性髋部骨折患者有 4183 人，脑出血患者有 1781 人。COPD（校正风险比=0.92，95%CI：0.81-1.04，P=0.222）、脑出血（校正风险比=1.01，95%CI：0.86-1.16，P=0.935）或急性髋部骨折（校正风险比=0.78，95%CI：0.54-1.03，P=0.13）患者的 30 天院内死亡率均无明显的周末效应。急性心肌梗死患者的周末效应显著（校正风险比=1.15，95%CI：1.03-1.26，P=0.007）。2 天院内死亡率也显示出类似的结果。
这是在澳大利亚进行的关于“周末效应”的第一项研究（队列并非来自新生儿），也是全球范围内首次专门评估 COPD 患者的周末效应的研究。观察到的模式与海外研究一致。心肌梗死存在显著的周末效应。需要进一步研究以确定澳大利亚急性医疗状况的周末效应是否受地点（如农村）、临床（如疾病严重程度）和服务提供因素（如侵入性程序的获取）的影响。
