Brouns Steffie H A, Wachelder Joyce J, Jonkers Femke S, Lambooij Suze L, Dieleman Jeanne P, Haak Harm R
Department of Internal Medicine, Máxima Medical Centre, 5600 BM, Eindhoven/Veldhoven, the Netherlands.
Maastricht University, Department of Health Services Research, and CAPHRI School for Public Health and Primary Care, 6229 ER, Maastricht, the Netherlands.
BMC Emerg Med. 2018 Mar 7;18(1):9. doi: 10.1186/s12873-018-0160-y.
Studies investigating different medical conditions and settings have demonstrated mixed results regarding the weekend effect. However, data on the outcome of elderly patients hospitalised on weekends is scarce. The objective was to compare in-hospital and two-day mortality rates between elderly emergency department (ED) patients (≥65 years) admitted on weekends versus weekdays.
A retrospective cohort study of emergency department visits of internal medicine patients ≥65 years presenting to the emergency department between 01 and 09-2010 and 31-08-2012 was conducted. The weekend was defined as the period from midnight on Friday to midnight on Sunday.
Data on 3697 emergency department visits by elderly internal medicine patients (mean age 78.6 years old) were included. In total, 2743 emergency department visits (74.2%) resulted in hospitalisation, of which 22.9% occurred on weekends. Comorbidity and urgency levels were higher in patients admitted on weekends. In-hospital mortality was 11.4% for patients admitted on weekends compared with 8.9% on weekdays (OR 1.3, 95%CI 0.99-1.8). Two-day mortality was 3.2% in patients hospitalised on weekends versus 1.9% on weekdays (OR 1.7, 95%CI 0.99-2.9). Multivariable adjustment for age, comorbidity and triage level demonstrated comparable in-hospital and two-day mortality for weekend and week admission (ORadj 1.2, 95%CI 0.9-1.7 and ORadj 1.5, 95%CI 0.8-2.6, resp.).
A small weekend effect was observed in elderly internal medicine patients, which was not statistically significant. This effect was partly explained by a higher comorbidity and urgency level in elderly patients hospitalised on weekends than during weekdays. Emergency care for the elderly is not compromised by adjusted logistics during the weekend.
针对不同医疗状况和环境的研究表明，关于周末效应的结果参差不齐。然而，关于周末住院老年患者结局的数据却很匮乏。目的是比较周末与工作日入院的老年急诊科（ED）患者（≥65岁）的院内死亡率和两日死亡率。
对2010年1月至9月以及2012年8月31日期间年龄≥65岁的内科患者到急诊科就诊情况进行了一项回顾性队列研究。周末定义为从周五午夜至周日午夜的时间段。
纳入了3697例老年内科患者急诊科就诊的数据（平均年龄78.6岁）。总共有2743例急诊科就诊（74.2%）导致住院，其中22.9%发生在周末。周末入院患者的合并症和紧急程度更高。周末入院患者的院内死亡率为11.4%，而工作日为8.9%（比值比1.3，95%置信区间0.99 - 1.8）。周末住院患者的两日死亡率为3.2%，工作日为1.9%（比值比1.7，95%置信区间0.99 - 2.9）。对年龄、合并症和分诊级别进行多变量调整后，周末和工作日入院的院内死亡率和两日死亡率相当（调整后比值比分别为1.2，95%置信区间0.9 - 1.7和1.5，95%置信区间0.8 - 2.6）。
在老年内科患者中观察到了轻微的周末效应，但无统计学意义。这种效应部分是由于周末住院的老年患者比工作日的合并症和紧急程度更高。周末调整后勤保障后，老年患者的急诊护理并未受到影响。
