OTA 2009 Posters

Scientific Poster #7 Injury Prevention OTA-2009

Does Time of Day of Hospital Arrival Affect Mortality following Trauma?

Kenneth A. Egol, MD1 (5B-Exactech, Inc; 7-Biomet, Smith & Nephew, Stryker, Synthes;
8-Johnson & Johnson); Kevin F. Spratt, PhD2 (n);
Kenneth J. Koval, MD2 (3, 4, 5A, 10-Biomet; 4, 5A, 10-Stryker);
1NYU Hospital for Joint Diseases, New York, New York, USA;
2Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA

Purpose: Although most medical centers with emergency departments are equipped for 24-hour care, some “middle of the night” services may not be as robust as they are during daylight hours. This could have potential impact upon patient outcomes. This study assessed the effect of time of day of patient presentation to a hospital emergency department on in-hospital mortality following trauma.

Methods: National Trauma Data Bank (NTDB) Version 7.0 data were used. The target population was adult patients (≥18 years of age) who were treated at the hospital where they presented. Patients meeting the above criteria were excluded if there was no valid (1) mortality status, (2) arrival time information, (3) ISS, or (4) ACS (American College of Surgeons) designation of trauma level. Generalized linear modeling was used to determine the relative risk of mortality associated with patient arrival time (morning [6 am-12 pm], afternoon [12 pm-6 pm], evening [6 pm-12 am], late night [12 am-6 am) and trauma level (Level 1, 2, or 3 and 4 combined), adjusting for patient personal (age, gender, race), health (comorbidities), injury (ISS), and general factors (region of the country and year of admission). All analyses were conducted using SAS version 9.2, running under the Windows XP operating system.

Results: In total, 601,388 patients met study inclusion and exclusion criteria. Relative to time of arrival, patients arriving late at night (12 am-6 am) were significantly younger and more likely to be male compared to the other time intervals evaluated. Injury severity and Deyo-Charlson comorbidity scores were relatively similar across the 4 arrival time intervals. Substantially higher adjusted relative risks (ARRs) for mortality were demonstrated for patients arriving late at night compared to morning (ARR = 1.21, P <0.0001) and afternoon (ARR = 1.26, P <0.0001), and were somewhat higher compared to arrivals during the evening (ARR = 1.09, P <0.0001). Overall, ARRs for mortality were also higher for night (6 pm-6 am) when referenced to the day arrivals (6 am-6 pm) (ARR= 1.18 P <0.0001. When considering trauma center level, ARRs for mortality were significantly higher for night compared to day arrivals for Level 1 (ARR = 1.10, P <0.0001); Level 2 (ARR = 1.14, P <0.0001), and for combined Levels 3 and 4 (ARR = 1.32, P <0.0001).

Conclusions: The highest risks for in-hospital mortality were associated with late night arrival times. However, when also considering the impact of trauma center level, the relative risk of morality for night compared to day arrivals was inversely related to trauma center level, being lowest for Level 1 trauma centers and highest for Level 3 and 4 trauma centers. This information may warrant a redistribution of hospital resources across the 24-hour day, especially at lower-level trauma centers, which might help reduce mortality rates following trauma.

Disclosure: (n=Respondent answered 'No' to all items indicating no conflicts; 1=Board member/owner/officer/committee appointments; 2=Medical/Orthopaedic Publications; 3=Royalties; 4=Speakers bureau/paid presentations; 5A=Paid consultant or employee; 5B=Unpaid consultant; 6=Research or institutional support from a publisher; 7=Research or institutional support from a company or supplier; 8=Stock or Stock Options; 9=Other financial/material support from a publisher; 10=Other financial/material support from a company or supplier).

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.