Jason W Busse1, Mohit Bhandari, P J Devereaux. 1. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. j.busse@utoronto.ca
Abstract
BACKGROUND: Previous studies have shown a relationship between time of admission to hospital and mortality rates; however, it is uncertain whether such a relationship exists for patients requiring emergency trauma surgery. METHODS: We included all trauma patients, except those with moderate to severe burns, who presented to a university-affiliated level 1 trauma center and underwent surgery, from 1995 until 2001 (n = 1044). We conducted univariate and multivariate analyses in which the dependent variables were in-hospital mortality and major complications, and the independent variables were the time of presentation to the trauma centre (nighttime vs. daytime, weekend vs. weekday, month of year, and year), age, sex, injury severity score, type of operative procedure, and total number of operative procedures. RESULTS: None of the factors related to time of presentation were associated with major complications or mortality. Factors predictive of increased mortality were higher ISS (odds ratio 1.07; 95% confidence interval 1.03-1.08), older age (1.04; 1.03-1.07), operations involving the cardiovascular system (1.7; 1-2.6), "miscellaneous" operative procedures (1.8; 1.1-2.9), and major complications (2.4; 1.4-4.2). INTERPRETATION: Time of presentation for emergency trauma surgery was not associated with differences in major complications or in mortality.
BACKGROUND: Previous studies have shown a relationship between time of admission to hospital and mortality rates; however, it is uncertain whether such a relationship exists for patients requiring emergency trauma surgery. METHODS: We included all traumapatients, except those with moderate to severe burns, who presented to a university-affiliated level 1 trauma center and underwent surgery, from 1995 until 2001 (n = 1044). We conducted univariate and multivariate analyses in which the dependent variables were in-hospital mortality and major complications, and the independent variables were the time of presentation to the trauma centre (nighttime vs. daytime, weekend vs. weekday, month of year, and year), age, sex, injury severity score, type of operative procedure, and total number of operative procedures. RESULTS: None of the factors related to time of presentation were associated with major complications or mortality. Factors predictive of increased mortality were higher ISS (odds ratio 1.07; 95% confidence interval 1.03-1.08), older age (1.04; 1.03-1.07), operations involving the cardiovascular system (1.7; 1-2.6), "miscellaneous" operative procedures (1.8; 1.1-2.9), and major complications (2.4; 1.4-4.2). INTERPRETATION: Time of presentation for emergency trauma surgery was not associated with differences in major complications or in mortality.