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Study: Head trauma outcomes worse on weekends

Sunday September 9, 2012
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Older adults who sustain substantial head trauma during the weekend are significantly more likely to die from their injuries than those similarly hurt and hospitalized Monday through Friday, according to a study, even if their injuries are less severe and they have fewer comorbidities.

The "weekend effect" on patient outcomes has been well-documented in cases of myocardial infarction, stroke and aneurism treatment, according to the study authors. Reduced staffing levels and/or lack of ready access to specialists may be factors in the higher weekend death rates after head injury.

"There isnít a medical reason for worse results on weekends," Eric B. Schneider, the studyís lead author and an epidemiologist at the Johns Hopkins University School of Medicineís Center for Surgical Trials and Outcomes Research, said in a news release.

"Itís more likely a difference in how hospitals operate over the weekend as opposed to during the week, meaning that there may be a real opportunity for hospitals to change how they operate and save lives."

Approximately 1.4 million Americans suffer head trauma that results in a hospital visit each year, the researchers wrote in background information for the study, which is scheduled for publication in the Journal of Surgical Research, and more than 50,000 die annually as a result of their injuries. An estimated 235,000 require inpatient care.

Schneider noted that unlike other forms of trauma that disproportionately affect young people, head trauma and mortality associated with it increase as people age, with the highest rates of hospitalization and death for such injuries occurring in people over 75.

Using data from the Healthcare Cost and Utilization Projectís Nationwide Inpatient Sample from 2006 to 2008, Schneider and his colleagues examined records from 38,675 people ages 65 to 89 who were admitted to U.S. hospitals with head trauma. Among those patients, 9,937 admissions (25.6%) occurred on weekends.

Overall, the researchers found that weekend patients were 14% more likely to die from their injuries than weekday patients, even after accounting for other factors. For example, the ages of patients admitted on weekends were similar to those admitted on weekdays, and weekend patients had less severe head trauma and fewer comorbidities than those admitted during the week.

Cost of care, measured as charges to patients, was roughly the same, the investigators noted, suggesting that weekend and weekday patients received similar treatments. Differences in the timing of treatments could not be examined in the available data, however.

Patients in the study were evaluated and treated at trauma centers, teaching hospitals and community hospitals, but the researchers could not tell from the available data which type of facility saw which patient. Other research has found a diminished weekend effect in patients taken to Level 1 trauma centers, where highly specialized staff is available 24 hours a day, seven days a week, the study authors said.

Schneider speculated that in addition to having fewer experienced physicians and nurses working on weekends, some hospitals may also experience delays in getting specialists such as neurosurgeons to the hospital.

An obvious solution, Schneider said, is to staff every hospitals on weekends at the same optimal level as weekdays. That step may be impractical and too expensive, he acknowledged. A more practical approach might be for emergency medical personnel to transport older patients with head injuries directly to the nearest trauma center, bypassing closer facilities that cannot provide that level of care.

The study abstract is available at www.journalofsurgicalresearch.com/article/S0022-4804%2812%2900590-2/abstract.


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