Weekend hospital admission is associated with higher instances of death in cardiovascular emergencies and stroke, but the effect of weekend admissions on head trauma patients is not well defined. Researchers from University of Texas Southwestern Medical School, Johns Hopkins University School of Medicine, and The Johns Hopkins Bloomberg School of Public Health, used data from the 2006, 2007 and 2008 Nationwide Inpatient Sample — a large publicly available dataset that contains a sampling of data for seven million hospital stays each year — to determine if older adults admitted to the hospital for head trauma over the weekend were at a higher mortality risk than those admitted during the week.
“Older adults are some of the most vulnerable members of our society, and multiple studies point to differences in outcomes for older adult patients. After seeing the weekend trend in other areas, we wanted to see if a similar pattern existed for older adult patients suffering traumatic head injuries,” says Lead Investigator in the study, Salman Hirani, MD, who is now a second-year resident in the department of rehabilitation medicine at Icahn School of Medicine at Mount Sinai.
The team identified 38,675 head injury patients in the sample who met their criteria —including serious and severe head injuries based on the Abbreviated Injury Scale, which measures injuries from minor to not survivable. From the initial group, they isolated 9,937 patients who were admitted on the weekend. The average age of both weekend and weekday patients was 78. Weekend patients had fewer additional injuries and co-existing diseases outside of head trauma than those admitted during the week. Weekend patients were also predominantly female when compared to weekday patients (52 percent vs. 50).
Dr. Hirani noted the median length of stay in the hospital was one day shorter for weekend patients (four days vs. five), and there were no significant differences in the charges incurred during each patient’s stay – both groups averaged around $27,000 per patient per stay.
Where the groups differed was in the percentage of patients who did not survive their injuries – with weekend patients having a 14 percent higher risk of death than weekday patients. “Overall, weekend patients were less severely injured, had fewer co-existing diseases and conditions, and generated the same amount of charges for their care as weekday patients, yet they experienced a greater likelihood of death,” says Dr. Hirani. “While we are not sure of the exact reason for this, we can continue to investigate and encourage hospitals to take a look at their own outcomes in order to put into place policies that would improve survival for older adults with traumatic brain injuries. Ultimately, we know that Level I trauma centers do not exhibit this weekend effect. It may then be important for an older adult with a TBI, especially those occurring over the weekend, to be admitted to or transferred to a Level I trauma center or a facility with full time staffing around the clock as these patients may require closer observation.”
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TBI and the Weekend Effect: Are Older Adults Safe? Salman Hirani, MD Objectives: Weekend admission is associated with mortality in cardiovascular emergencies and stroke but the effect of weekend admission for trauma is not well defined. We sought to determine whether differences in mortality outcomes existed for older adults with substantial head trauma admitted on a weekday versus over the weekend. Design: Data from the 2006, 2007, and 2008 Nationwide Inpatient Sample were combined and head trauma admissions were isolated. Abbreviated injury scale (AIS) scores were calculated using ICDMAP-90 Software. Individuals aged 65 to 89 y with head AIS equal to 3 or 4 and no other region score < 3 were included. Individual Charlson comorbidity scores were calculated and individuals with missing mortality, sex, or insurance data were excluded. Wilcoxon rank sum and Student t-tests compared demographics, length of stay, and total charges for weekday versus weekend admissions. The χ2 tests compared sex and head injury severity. Logistic regression modeled mortality adjusting for age, sex, injury severity, comorbidity, and insurance status. Results: Of the 38,675 patients meeting criteria, 9937 (25.6%) were admitted on weekends. Mean age was similar (78.4 versus 78.4, P = 0.796) but more weekend admissions were female (51.6% versus 50.2%, P = 0.022). Weekend patients demonstrated slightly lower comorbidity (mean Charlson = 1.07 versus 1.14, P < 0.001) and head injury severity (58.3% versus 60.8% AIS = 4, P < 0.001). Median weekend length of stay was shorter (4 versus 5 d, P < 0.001). Weekend and weekday median total charges did not differ ($27,128 versus $27,703, respectively, P = 0.667). Proportional mortality was higher among weekend patients (9.3% versus 8.4%, P = 0.008). After adjustment, weekend patients demonstrated 14% increased odds of mortality (OR 1.14, 95% CI 1.05-1.23). Conclusions: Older adults with substantial head trauma admitted on weekends are less severely injured, carry less comorbidity, and generate similar total charges compared with those admitted on weekdays. However, after accounting for known risk confounders, weekend patients demonstrated 14% greater odds of mortality. For those that do survive long term morbidity and functional capacity is not noted in the literature. Early rehab intervention has been shown reduce morbidity in such patients and could be critical for patient’s long term survival.
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