The Patterns and Impact of Off-Working Hours, Weekends and Seasonal Admissions of Patients with Major Trauma in a Level 1 Trauma Center

Abstract

Background: The trauma incidence follows specific patterns in different societies and is expected to increase over the weekend and nighttime. We aimed to explore and analyze the incidence, pattern, and severity of trauma at different times (working hours vs. out off-working hours, weekdays vs. weekends and season). Methods: A retrospective analysis was conducted at a level 1 trauma facility in Qatar. All injured patients admitted between June 2017 and May 2018 were included. The data were analyzed to determine whether outcomes and care parameters of these patients differed between regular working hours and off-working hours, weekdays vs. weekends, and between season intervals. Results: During the study period, 2477 patients were admitted. A total of 816 (32.9%) patients presented during working hours and 1500 (60.6%) during off-working hours. Off-working hours presentations differed significantly with the injury severity score (ISS) (p  <  0.001), ICU length of stay (p  =  0.001), blood transfusions (p = 0.001), intubations (p = 0.001), mortality rate (9.7% vs. 0.7%; p < 0.001), and disposition to rehabilitation centers. Weekend presentations were significantly associated with a higher ISS (p = 0.01), Priority 1 trauma activation (19.1% vs. 14.7%; p = 0005), and need for intubation (21% vs. 16%; p = 0.002). The length of stay (ICU and hospital), mortality, and disposition to rehabilitation centers and other clinical parameters did not show any significant differences. No significant seasonal variation was observed in terms of admissions at the trauma center. Conclusions: The off-working hours admission showed an apparent demographic effect in involved mechanisms, injury severity, and trauma activations, while outcomes, especially the mortality rate, were significantly different during nights but not during the weekends. The only observed seasonal effect was a decrease in the number of admissions during the summer break.