Department of Emergency and Critical Care Medicine, Tokyobay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 279-0001, Japan.
Department of Surgery, Okinawa Chubu Hospital, 281 Miyazato, Uruma, Okinawa, 904-2293, Japan.
Pediatr Surg Int. 2024 Nov 25;41(1):5. doi: 10.1007/s00383-024-05895-7.
The "out-of-hours effect," which indicates hospital admittance during weekends or nighttime, has poorer outcomes for patients than for those admitted on weekdays and is widely documented in various medical conditions. However, this effect remains understudied in pediatric trauma cases, including blunt liver and spleen injuries (BLSIs).
This was a secondary analysis of a nationwide multicenter retrospective study, focusing on pediatric patients with trauma (≤ 16 years old) with BLSI admitted from 2008 to 2019. This study evaluated the association between out-of-hour admissions and outcomes. The primary outcome was the intervention rate and secondary outcomes were 30-day mortality and time from hospital arrival to the first intervention.
This study identified 1414 pediatric patients with BLSI. In total, 681 events occurred during the daytime and 733 during the nighttime, with 927 weekday and 487 weekend events. Out-of-hour admissions did not significantly associate with a higher rate of intervention. This association remained after adjusting for five potential confounders and patient clustering within the hospital. In addition, Out-of-hour admissions did not significantly associated with 30-day mortality, or time from hospital arrival to the first intervention.
The current study showed no significant difference in treatment strategy and outcomes between weekday and out-of-hour among children with BLSI.
“非工作时间效应”是指患者在周末或夜间住院，其预后比在工作日住院更差，这在各种医疗条件下都有广泛的记载。然而，这种效应在儿科创伤病例中，包括钝性肝脾损伤（BLSI），研究得还不够充分。
这是一项全国多中心回顾性研究的二次分析，研究对象为 2008 年至 2019 年期间因 BLSI 而住院的年龄在 16 岁以下的创伤患儿。本研究评估了非工作时间入院与结局之间的关系。主要结局是干预率，次要结局是 30 天死亡率和从入院到首次干预的时间。
本研究纳入了 1414 例 BLSI 患儿。白天共发生 681 例，夜间共发生 733 例，其中 927 例发生在工作日，487 例发生在周末。非工作时间入院与干预率的升高无显著相关性。在校正了五个潜在混杂因素和医院内的患者聚类后，这种相关性仍然存在。此外，非工作时间入院与 30 天死亡率或从入院到首次干预的时间也无显著相关性。
本研究表明，BLSI 患儿在工作日和非工作时间的治疗策略和结局没有显著差异。
