No ‘weekend effect’ seen in trauma cases

People who suffer a traumatic injury during the weekend or at night will fare just as well as people injured during the day or on a weekday, as long as they make it to a Level 1 trauma center for treatment, new findings show.

While studies have shown that people who have a heart attack or stroke during a hospital’s off hours are less likely to survive, Dr. Brendan G. Carr of the University of Pennsylvania School of Medicine in Philadelphia and his colleagues found no evidence for such a “weekend effect” among trauma patients.

Hospital staffing fluctuates around the clock and throughout the week, but Level 1 trauma centers like the one at the Hospital of the University of Pennsylvania must always have a trauma surgeon immediately available, Carr noted in an interview.

"Patients arriving at a hospital with a heart attack or a stroke may find themselves at a facility unable to optimally manage their condition - especially at night and on a weekend,” Carr noted in a university-issued statement. “We found that no matter when you are injured, you get the same type of care when you are brought to a trauma center.”

Carr’s team looked at 4,382 trauma patients treated at the hospital between 2006 and 2008. About a third arrived for treatment over the weekend, while just under a quarter were admitted at night.

No matter what type of injury a patient had, or what sort of outcome the researchers looked at, patients admitted at night or on the weekend did just as well—and, in some cases, slightly better—than patients admitted on a weekday. This was the case both for blunt traumas (car crashes, head injuries or beatings) and penetrating traumas (most often gunshot and knife wounds).

“Trauma care in the United States,” Carr said, “is a totally different animal” than care for other conditions. Guidelines for how trauma centers should be staffed, and for how to get patients to these centers, have been in place for decades, he explained, and the trauma system has been shown to save lives.

While the idea would be for the health care system to develop a similarly well coordinated approach to treating patients with stroke, heart attack and other non-traumatic life-threatening emergencies, for many reasons, this is a much more complex proposition, Carr told Reuters Health.

For example, trying to stop someone from bleeding to death is a relatively simple matter, Carr pointed out, compared to figuring out when and how to give stroke patients clot-busting drugs. “I see the challenge as developing the delivery system at the same time as we develop the science,” he said.

Another issue, he noted, is that maintaining 24-7 readiness for trauma treatment is extremely expensive.

One possibility for improving emergency care even at small hospitals during off hours, he suggested, could be to hook staff up with expert doctors at other hospitals using Skype-like technology. “I do think that there is a lot of hope.”

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By Anne Harding

NEW YORK (Reuters Health)

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