The off-hour effect among severe trauma patients: a nationwide cohort study in Japan
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ORIGINAL ARTICLE
The off‑hour effect among severe trauma patients: a nationwide cohort study in Japan Makoto Aoki1 · Toshikazu Abe2,3 · Yosuke Matsumura4 · Shuichi Hagiwara5 · Daizoh Saitoh6 · Kiyohiro Oshima1 Received: 10 March 2020 / Accepted: 12 May 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose To assess whether there are temporal differences altering the clinical outcomes of severe trauma patients in Japan. Methods This was a retrospective cohort study that used recorded data from the Japan Trauma Data Bank. Severe trauma patients who had an injury severity score of greater than 16 were included. The hospital arrival time was categorized into daytime (8 a.m.–7:59 p.m.) and nighttime (8 p.m.–7:59 a.m.). The hospital arrival day of the week was categorized into business days and non-business days. The primary outcome was in-hospital mortality. Results A total of 65,136 severe trauma patients were analyzed. In-hospital mortality was 15.6% in the daytime and 14.4% in the nighttime, and 15.5%, and 14.6% on business days and non-business days, respectively. Nighttime was associated with decreased in-hospital mortality compared to daytime (odds ratio = 0.817, 95% confidence interval = 0.764–0.874) and a non-business day was not associated with in-hospital mortality. Conclusions We did not find a negative off-hour effect on in-hospital mortality among severe trauma patients. Keywords Off-hour effect · Trauma · Patient load · Hospital resources · Mixed-effect model
Introduction Trauma is one of the major causes of death worldwide, and it is a significant issue for medical care and resources. The quality of trauma patient care has been reported to decrease when hospital resources are limited [1], and well-defined trauma centers are required to maintain hospital medical resources at all times. Hospital medical resources such as Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00595-020-02027-1) contains supplementary material, which is available to authorized users.
a transfer system, and human resources such as the availability of surgical procedures are assumed to easily reach full capacity and, thus, become unable to handle all cases in a timely manner, especially on nights and weekends. The resulting negative effect on the patient outcome has been called a negative off-hour effect [2], which could be a risk factor for adverse events including cardiac arrest [3], myocardial infarction [4], stroke [5] and pulmonary embolism [2]. Previous reports showed that a negative off-hour effect on mortality of trauma patients did not exist in American and
* Makoto Aoki aokimakoto@gunma‑u.ac.jp
1
Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
Toshikazu Abe [email protected]
2
Department of General Medicine, Juntendo University, Tokyo, Japan
Yosuke Matsumura [email protected]
3
Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
Shuichi Hagi
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