According to a John Hopkins study, older adults who experience a severe head trauma over a weekend have a significantly higher chance of dying from their injuries than those similarly hurt and visiting hospital from Monday to Friday, even if their injuries are not as severe and have fewer other illnesses than those hospitalized on weekdays.
Patients undergoing heart attack, stroke, and aneurism treatment have also experienced this “weekend effect”, which has been well documented. This new research affirms this effect and the problems in head trauma care. The findings were published in the Journal of Surgical Research, and explain that because hospitals are less staffed on the weekends and because the patients do not have ready access to specialists are factors in these higher weekend deaths from head injuries.
Eric B. Schneider, Ph.D., study leader and an epidemiologist at the John Hopkins University School of Medicine’s Center for Surgical Trials and Outcomes Research, said:
“There isn’t a medical reason for worse results on weekends. It’s more likely a difference in how hospitals operate over the weekend as opposed to during the week, meaning that there may be a real opportunity for hospitals to change how they operate and save lives.”
Each year, there are an estimated 1.4 million Americans who suffer head trauma that result in a hospital visit. Over 50,000 of those patients die annually as a result of their injuries, while around 235,000 need inpatient care.
Schneider pointed out that head trauma, and mortality associated with it, increase as people get older, unlike other forms of trauma that disproportionately affect younger people. People over the age of 75 have the highest rates of hospitalizations and death because of head injuries.
The experts analyzed records from 38,675 people between the ages of 65 and 89 that were admitted to U.S. hospitals with head trauma. They used data from the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample from 2006 to 2008 and found that 9,937 admissions (25.6%) occurred on weekends.
Results showed that weekend patients were 14% more likely to die from their head injuries than weekday patients, even after other factors were accounted for. For example, the patients admitted on weekends and weekdays had similar ages, ruling out age as a factor. Weekend patients were less sick with other illnesses and even had less severe head trauma than weekday admissions.
The researchers added that the cost of care, measured as charges to patients, was about the same, showing that weekend and weekday patients received similar treatments. Unfortunately, any differences in the timing of the treatments could be not observed in the data they had.
The available data did not specify which facility saw which patient, but they were looked at and evaluated at either trauma centers, teaching hospitals, or community hospitals. Other research has observed Level 1 trauma centers with specialized staff that is available 24/7 and found that there is a decreased weekend effect in patients taken there. The John Hopkins Hospital is a Level 1 trauma center.
Hospitals have fewer doctors and nurses working on the weekend, Schneider explained, and some might even have trouble bringing in specialists, like neurosurgeons, to the hospital on a Saturday or Sunday.
He concluded that every hospital on weekends should be staffed at the same optimal level as weekdays, but realizes it is probably impractical and expensive. He suggests that it could be more practical to have emergency medical personnel transport older patients with head injuries directly to the closest trauma center, and ignore facilities that cannot give the highest level of care.
Written by Sarah Glynn