OBJECTIVE: To examine the effect of the "after-hours" (18:00-07:00) model of trauma care on a high-risk subgroup - patients presenting with acute traumatic coagulopathy (ATC). DESIGN, PARTICIPANTS AND SETTING: Retrospective analysis of data from the Alfred Trauma Registry for patients with ATC presenting between 1 January 2006 and 31 December 2011. MAIN OUTCOME MEASURE: Mortality at hospital discharge, adjusted for potential confounders, describing the association between after-hours presentation and mortality. RESULTS: There were 398 patients with ATC identified during the study period, of whom 197 (49.5%) presented after hours. Mortality among patients presenting after hours was 43.1%, significantly higher than among those presenting in hours (33.1%; P = 0.04). Following adjustment for possible confounding variables of age, presenting Glasgow Coma Scale score, urgent surgery or angiography and initial base deficit, after-hours presentation was significantly associated with higher mortality at hospital discharge (adjusted odds ratio, 1.77; 95% CI, 1.10-2.87). CONCLUSION: The after-hours model of care was associated with worse outcomes among some of the most critically ill trauma patients. Standardising patient reception at major trauma centres to ensure a consistent level of care across all hours of the day may improve outcomes among patients who have had a severe injury.
OBJECTIVE: To examine the effect of the "after-hours" (18:00-07:00) model of trauma care on a high-risk subgroup - patients presenting with acute traumatic coagulopathy (ATC). DESIGN, PARTICIPANTS AND SETTING: Retrospective analysis of data from the Alfred Trauma Registry for patients with ATC presenting between 1 January 2006 and 31 December 2011. MAIN OUTCOME MEASURE: Mortality at hospital discharge, adjusted for potential confounders, describing the association between after-hours presentation and mortality. RESULTS: There were 398 patients with ATC identified during the study period, of whom 197 (49.5%) presented after hours. Mortality among patients presenting after hours was 43.1%, significantly higher than among those presenting in hours (33.1%; P = 0.04). Following adjustment for possible confounding variables of age, presenting Glasgow Coma Scale score, urgent surgery or angiography and initial base deficit, after-hours presentation was significantly associated with higher mortality at hospital discharge (adjusted odds ratio, 1.77; 95% CI, 1.10-2.87). CONCLUSION: The after-hours model of care was associated with worse outcomes among some of the most critically ill traumapatients. Standardising patient reception at major trauma centres to ensure a consistent level of care across all hours of the day may improve outcomes among patients who have had a severe injury.
Authors: Gowri Shivasabesan; Gerard M O'Reilly; Joseph Mathew; Mark C Fitzgerald; Amit Gupta; Nobhojit Roy; Manjul Joshipura; Naveen Sharma; Peter Cameron; Madonna Fahey; Teresa Howard; Zoe Cheung; Vineet Kumar; Bhavesh Jarwani; Kapil Dev Soni; Pankaj Patel; Advait Thakor; Mahesh Misra; Russell L Gruen; Biswadev Mitra Journal: World J Surg Date: 2019-10 Impact factor: 3.352
Authors: Sriram Ramgopal; Jennifer Dunnick; Nalyn Siripong; Kavitha A Conti; Barbara A Gaines; Noel S Zuckerbraun Journal: World J Surg Date: 2019-09 Impact factor: 3.352
Authors: Biswadev Mitra; Rob D Mitchell; Geoffrey C Cloud; Dion Stub; Minh Nguyen; Shane Nanayakkara; Jean-Philippe Miller; Gerard M O'Reilly; De Villiers Smit; Peter A Cameron Journal: Emerg Med Australas Date: 2020-09-12 Impact factor: 2.279