The Patterns and Impact of Off-Working Hours, Weekends and Seasonal Admissions of Patients with Major Trauma in a Level 1 Trauma Center
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population and Setting
2.2. Exposures, Variables, and Outcome Measures
2.3. Statistical Analysis
3. Results
3.1. Comparison of Patients Admitted during Working Hours and Off-Working Hours (Off-Hours Effect)
3.2. Comparison of Patients Admitted on Weekdays and Weekends (Weekend’s Effect)
3.3. Comparison of Patients Admitted to Hospital Stratified by Seasons (Season’s Effect)
3.4. Survivors versus Non-Survivors
3.5. Predictors of Mortality in Trauma Patients
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Working Hours (06:01–15:00 h) n = 816 | Off-Working Hours (15:01–06:00 h) n = 1500 | Odd Ratio (95% CI) | p-Value | |
---|---|---|---|---|
Age (years) | 33.5 ± 15.3 | 28.8 ± 15.5 | - | 0.001 |
≤15 | 74 (9.2%) | 257 (17.9%) | 3.91 (2.27–6.71) | 0.001 for all |
16–64 | 698 (86.4%) | 1143 (79.8%) | 1.84 (1.13–2.99) | |
≥65 | 36 (4.5%) | 32 (2.2%) | 1 (Ref) | |
Males | 708 (86.8%) | 1250 (83.3%) | 1.31 (1.03–1.67) | 0.02 for all |
Females | 108 (13.2%) | 250 (16.7%) | 1 (Ref) | |
Mechanism of injury | 0.001 for all | |||
RTI | 435 (53.3%) | 713 (47.5%) | 0.61 (0.48–0.76) | |
Fall | 241 (29.5%) | 410 (27.3%) | 0.63 (0.49–0.81) | |
Others | 140 (17.2%) | 377 (25.1%) | 1 (Ref) | |
Priority of activation | ||||
P1 | 44 (5.4%) | 339 (22.6%) | 3.91 (2.68–5.71) | 0.001 for all |
P2 | 642 (78.7%) | 905 (60.3%) | 0.72 (0.56–0.90) | |
Others | 130 (15.9%) | 256 (17.1%) | 1 (Ref) | |
Response time | 7 (1–56) | 7 (1–132) | - | 0.23 |
Scene Time ≤ 20 min. (n = 1686) | 326 (52.1%) | 512 (48.3%) | 1 (Ref) | 0.13 for all |
Scene Time > 20 min. | 300 (47.9%) | 548 (51.7%) | 1.16 (0.95–1.42) | |
Prehospital time≤ 60 min. (n = 1736) | 193 (30.0%) | 381 (34.9%) | 1 (Ref) | 0.03 for all |
Pre-hospital time> 60 min. | 450 (70.0%) | 712 (65.1%) | 0.80 (0.65–0.99) | |
Blood Transfusion | 71 (8.7%) | 256 (17.1%) | 2.16 (1.64–2.85) | 0.001 |
MTP Activated | 6 (0.7%) | 80 (5.3%) | 7.60 (3.30–17.51) | 0.001 |
Surgery within 24 h | 144 (17.6%) | 320 (21.3%) | 1.27 (1.02–1.57) | 0.03 |
Intubation | 41 (5.0%) | 366 (24.4%) | 6.10 (4.36–8.53) | 0.001 |
Exploratory laparotomy | 20 (2.5%) | 78 (5.2%) | 2.18 (1.33–3.60) | 0.002 |
ISS (mean ± SD) | 11.2 ± 7.8 | 14.8 ± 11.6 | - | 0.001 |
ICU LOS (days) | 3 (1–76) | 4 (1–102) | - | 0.001 |
Hospital LOS (days) * | 4 (1–120) | 4 (1–166) | - | 0.70 |
Transferred to rehabilitation | 31 (3.8%) | 93 (6.2%) | 1.67 (1.10–2.54) | 0.01 |
Mortality | 6 (0.7%) | 145 (9.7%) | 14.45 (6.35–32.84) | 0.001 |
Weekdays (n = 1749) | Weekend * (n = 728) | Odd Ratio (95% CI) | p-Value | |
---|---|---|---|---|
Age (years) | 31.1 ± 15.7 | 30.4 ± 16.3 | - | 0.37 |
≤15 | 228 (13.5%) | 115 (16.5%) | 1.31 (0.76–2.24) | 0.16 for all |
16–64 | 1405 (83.1%) | 560 (80.3%) | 1.03 (0.62–1.71) | |
≥65 | 57 (3.4%) | 22 (3.2%) | 1 (Ref) | |
Males | 1493 (85.4%) | 596 (81.9%) | 1.29 (1.03–1.63) | 0.02 for all |
Females | 256 (14.6%) | 132 (18.1%) | 1 (Ref) | |
Mechanism of injury | 0.12 for all | |||
RTI | 844 (48.3%) | 371 (51.0%) | 0.99 (0.80–1.23) | |
Fall | 516 (29.5%) | 185 (25.4%) | 0.81 (0.63–1.04) | |
Others | 389 (22.2%) | 172 (23.6%) | 1 (Ref) | |
Priority of activation | ||||
P1 | 257 (14.7%) | 139 (19.1%) | 1.63 (1.21–2.19) | 0.01 for all |
P2 | 1164 (66.6%) | 480 (65.9%) | 1.24 (0.97–1.58) | |
Others | 328 (18.8%) | 109 (15.0%) | 1 (Ref) | |
Response time | 7 (1–89) | 7 (1–132) | - | 0.83 |
Scene Time ≤ 20 min. (n = 1806) | 641 (51.0%) | 258 (46.9%) | 1 (Ref) | 0.10 for all |
Scene Time > 20 min. | 615 (49.0%) | 292 (53.1%) | 1.18 (0.97–1.44) | |
Prehospital time≤ 60 min. (n = 1852) | 400 (31.0%) | 208 (37.0%) | 1 (Ref) | 0.01 for all |
Pre-hospital time> 60 min. | 890 (69.0%) | 354 (63.0%) | 0.77 (0.62–0.94) | |
Blood Transfusion | 232 (13.3%) | 108 (14.8%) | 1.14 (0.89–1.46) | 0.30 |
MTP Activated | 56 (3.2%) | 32 (4.4%) | 1.39 (0.89–2.17) | 0.14 |
Surgery within 24 h | 329 (18.8%) | 145 (19.9%) | 1.07 (0.86–1.34) | 0.52 |
Intubation | 275 (15.7%) | 152 (20.9%) | 1.41 (1.14–1.76) | 0.002 |
Exploratory lap. | 73 (4.2%) | 27 (3.7%) | 0.88 (0.56–1.39) | 0.59 |
ISS (mean ± SD) | 12.8 ± 9.8 | 14.1 ± 11.1 | - | 0.01 |
ICU LOS (days) | 3 (1–102) | 4 (1–63) | - | 0.13 |
Hospital LOS (days) | 4 (1–166) | 4 (1–130) | - | 0.12 |
Transferred to rehabilitation | 89 (5.1%) | 42 (5.8%) | 1.14 (0.78–1.67) | 0.49 |
Mortality | 115 (6.6%) | 54 (7.4%) | 1.13 (0.81–1.59) | 0.44 |
Variable | June–August (n = 547) | September–November (n = 639) | December–February (n = 652) | March–May (n = 639) | p-Value |
---|---|---|---|---|---|
Age (years) | 31.3 ± 16.6 | 30.0 ± 14.4 | 30.6 ± 15.9 | 31.6 ± 16.4 | 0.29 |
≤15 | 78 (14.8%) | 77 (12.4%) | 91 (14.7%) | 97 (15.6%) | 0.54 for all |
16–64 | 435 (82.5%) | 527 (84.7%) | 505 (81.7%) | 499 (80.5%) | |
≥65 | 14 (2.7%) | 18 (2.9%) | 22 (3.6%) | 24 (3.9%) | |
Males | 474 (86.7%) | 535 (83.7%) | 552 (84.7%) | 529 (82.8%) | 0.30 for all |
Females | 73 (13.3%) | 104 (16.3%) | 100 (15.3%) | 110 (17.2%) | |
Mechanism of injury | 0.92 for all | ||||
RTI | 261 (47.7%) | 317 (49.6%) | 319 (48.9%) | 319 (49.9%) | |
Fall | 156 (28.5%) | 173 (27.1%) | 193 (29.6%) | 178 (27.9%) | |
Others | 130 (23.8%) | 149 (23.3%) | 140 (21.5%) | 142 (22.2%) | |
Priority of activation | |||||
P1 | 89 (16.3%) | 96 (15.0%) | 108 (16.6%) | 103 (16.1%) | 0.60 for all |
P2 | 373 (68.2%) | 436 (68.2%) | 423 (64.9%) | 413 (64.6%) | |
Others | 85 (15.5%) | 107 (16.7%) | 121 (18.6%) | 123 (19.2%) | |
Response time | 7 (1–132) | 7 (1–89) | 7 (1–41) | 7 (1–55) | 0.49 |
Scene Time ≤ 20 min. (n = 1807) | 169 (48.4%) | 218 (54.1%) | 267 (50.1%) | 247 (47.3%) | 0.20 for all |
Scene Time > 20 min. | 180 (51.6%) | 185 (45.9%) | 266 (49.9%) | 275 (52.7%) | |
Prehospital time ≤ 60 min. (n = 1853) | 118 (32.4%) | 143 (34.9%) | 178 (32.5%) | 169 (31.8%) | 0.77 for all |
Pre-hospital time > 60 min. | 246 (67.6%) | 267 (65.1%) | 369 (67.5%) | 363 (68.2%) | |
Blood Transfusion | 70 (12.8%) | 85 (13.3%) | 93 (14.3%) | 92 (14.4%) | 0.82 |
MTP Activated | 17 (3.1%) | 19 (3.0%) | 23 (3.5%) | 29 (4.5%) | 0.43 |
Surgery within 24 h | 118 (21.6%) | 124 (19.4%) | 109 (16.7%) | 123 (19.2%) | 0.20 |
Intubation | 87 (15.2%) | 98 (15.3%) | 121 (18.6%) | 121 (18.9%) | 0.22 |
Exploratory lap. | 26 (4.8%) | 23 (3.6%) | 22 (3.4%) | 29 (4.5%) | 0.53 |
ISS (mean ± SD) | 12.6 ± 10.1 | 13.3 ± 11.2 | 13.6 ± 9.9 | 13.3 ± 9.9 | 0.59 |
ICU LOS (days) | 3 (1–76) | 4 (1–62) | 4.5 (1–76) | 4 (1–102) | 0.19 |
Hospital LOS (days) | 4 (1–129) | 4 (1–82) | 4 (1–130) | 4 (1–166) | 0.70 |
Transferred to rehabilitation | 21 (3.8%) | 35 (5.5%) | 41 (6.3%) | 34 (5.3%) | 0.30 |
Mortality | 30 (5.5%) | 42 (6.6%) | 53 (8.1%) | 44 (6.9%) | 0.34 |
Variables | Survivors (n = 2308) | Non-Survivors (n = 169) | OR (95% CI) | p-Value |
---|---|---|---|---|
Age (years) | 30.8 ± 15.8 | 34.4 ± 16.0 | - | 0.03 |
Male gender | 1927 (83.5%) | 162 (95.9%) | 0.219 (0.102–0.469) | 0.001 |
Mechanism of injury | ||||
RTI | 1092 (47.3%) | 123 (72.8%) | 2.76 (1.73–4.39) | 0.001 |
Fall | 677 (29.3%) | 24 (14.2%) | 0.86 (0.47–1.58) | 0.63 |
Others | 539 (23.4%) | 22 (13.0%) | 1 (Ref) | 1 (Ref) |
Prehospital time ≤ 60 min | 558 (32.7%) | 50 (34.0%) | 1 (Ref) | |
Pre-hospital time > 60 min | 1147 (67.3%) | 97 (66.0%) | 0.94 (0.66–1.34) | 0.75 |
Priority of activation | ||||
P1 | 294 (12.7%) | 102 (60.4%) | 2.06 (1.45–2.92) | 0.001 |
P2 | 1640 (71.0%) | 4 (2.4%) | 0.01 (0.005–0.04) | 0.001 |
Others | 374 (16.2%) | 63 (37.3%) | 1 (Ref) | |
MTP activation | 50 (2.2%) | 38 (22.5%) | 13.10 (8.29–20.69) | 0.001 |
Surgery within 24h | 447 (19.4%) | 27 (16.0%) | 0.79 (0.52–1.21) | 0.27 |
Injury severity score | 12.3 ± 9.1 | 22.9 ± 15.7 | - | 0.001 |
Head injury | 504 (21.8%) | 104 (61.5%) | 5.72 (4.13–7.92) | 0.001 |
Admission on Working h * | 810 (37.4%) | 6 (4.0%) | 1 (Ref) | |
Admission Off-working h | 1353 (62.6%) | 146 (96.0%) | 14.46 (6.36–32.88) | 0.001 |
Weekday admission | 1634 (70.8%) | 115 (68.0%) | 1 (Ref) | 0.44 |
Weekend admission | 674 (29.2%) | 54 (32.0%) | 1.14 (0.81–1.59) | |
Season admission | ||||
June–August | 517 (22.4%) | 30 (17.8%) | 1 (Ref) | 0.34 |
September–November | 595 (25.8%) | 42 (24.9%) | 1.21 (0.75–1.98) | 0.42 |
December–February | 599 (26.0%) | 53 (31.4%) | 1.52 (0.95–2.42) | 0.07 |
March–May | 595 (25.8%) | 44 (26.0%) | 1.27 (0.78–2.05) | 0.31 |
Variables | Odd Ratio | 95% Confidence Interval | p-Value | |
---|---|---|---|---|
Lower | Upper | |||
Age | 1.020 | 1.004 | 1.035 | 0.01 |
Males | 0.549 | 0.188 | 1.598 | 0.27 |
Injury severity Score | 1.042 | 1.018 | 1.067 | 0.001 |
Head injury | 4.152 | 2.310 | 7.464 | 0.001 |
Massive transfusion protocol activation | 4.192 | 2.127 | 8.262 | 0.001 |
Off-working h | 6.329 | 2.673 | 14.985 | 0.001 |
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Abdelrahman, H.; Al-Thani, H.; Khan, N.A.; Mollazehi, M.; Asim, M.; El-Menyar, A. The Patterns and Impact of Off-Working Hours, Weekends and Seasonal Admissions of Patients with Major Trauma in a Level 1 Trauma Center. Int. J. Environ. Res. Public Health 2021, 18, 8542. https://doi.org/10.3390/ijerph18168542
Abdelrahman H, Al-Thani H, Khan NA, Mollazehi M, Asim M, El-Menyar A. The Patterns and Impact of Off-Working Hours, Weekends and Seasonal Admissions of Patients with Major Trauma in a Level 1 Trauma Center. International Journal of Environmental Research and Public Health. 2021; 18(16):8542. https://doi.org/10.3390/ijerph18168542
Chicago/Turabian StyleAbdelrahman, Husham, Hassan Al-Thani, Naushad Ahmad Khan, Monira Mollazehi, Mohammad Asim, and Ayman El-Menyar. 2021. "The Patterns and Impact of Off-Working Hours, Weekends and Seasonal Admissions of Patients with Major Trauma in a Level 1 Trauma Center" International Journal of Environmental Research and Public Health 18, no. 16: 8542. https://doi.org/10.3390/ijerph18168542