There Is No Weekend Effect in the Trauma Patient

Background: The presence of a weekend effect, that is, increased morbidity/mortality for patients admitted to the hospital on a weekend, has been reported in numerous studies across many specialties. Postulated causes include reduced weekend staffing, increased time between admission and undergoing procedures/surgery, and decreased subspecialty availability. The aim of this study is to evaluate if a weekend effect exists in trauma care in the United States. Methods: Using the 2012-2015 National In-patient Sample database from the Healthcare Cost and Utilization Project, adults with trauma diagnoses who were admitted non electively were analyzed. Using logistic and negative binomial regression adjusted for survey-related discharge weights and statistically significant covariables, mortality and length of stay (LOS) were assessed, respectively. Subgroup analysis was conducted using rural, urban teaching, and urban nonteaching hospital-type subgroups. Additional subgroup analysis of patients who required surgery during admission was also performed. Results: A total of 22,451 patients were identified, with 3.94% admitted to rural and 81.42% to urban hospitals. Weekend admission did not have a statistically significant difference in adjusted-mortality (OR 0.928; 95% CI 0.858-1.003; P = 0.059) or LOS (IRR 0.978; 95% CI 0.9451.011; P = 0.199). There was also no statistically significant increase in mortality or LOS for weekend admits in any of the hospital subgroups. Conclusions: There does not appear to be a weekend effect for trauma admission. This may be explained by the nature of trauma care in the United States, in which there is often 24-h in-house coverage regardless of day of the week. Replicating a trauma service coverage schedule may help other services decrease the presence of the weekend effect. (C) 2020 Elsevier Inc. All rights reserved.

Automated summary

The study found no weekend effect in trauma care in the United States, possibly due to the 24-hour in-house coverage in trauma care services in the country. This suggests that replicating this coverage schedule may help decrease the weekend effect in other specialties.