Yosuke Matsumura1, Taka-Aki Nakada2, Toshikazu Abe3, Hiroshi Ogura4, Atsushi Shiraishi5, Shigeki Kushimoto6, Daizoh Saitoh7, Seitaro Fujishima8, Toshihiko Mayumi9, Yasukazu Shiino10, Takehiko Tarui11, Toru Hifumi12, Yasuhiro Otomo13, Kohji Okamoto14, Yutaka Umemura4, Joji Kotani15, Yuichiro Sakamoto16, Junichi Sasaki17, Shin-Ichiro Shiraishi18, Kiyotsugu Takuma19, Ryosuke Tsuruta20, Akiyoshi Hagiwara21, Kazuma Yamakawa22, Tomohiko Masuno23, Naoshi Takeyama24, Norio Yamashita25, Hiroto Ikeda26, Masashi Ueyama27, Satoshi Fujimi22, Satoshi Gando28. 1. Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. 2. Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. Electronic address: taka.nakada@nifty.com. 3. Department of General Medicine, Juntendo University, Tokyo, Japan; Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan. 4. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. 5. Emergency and Trauma Center, Kameda Medical Center, Chiba, Japan. 6. Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. 7. Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan. 8. Center for General Medicine Education, Keio University School of Medicine, Tokyo, Japan. 9. Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan. 10. Department of Acute Medicine, Kawasaki Medical School, Kawasaki, Japan. 11. Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan. 12. Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Japan. 13. Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan. 14. Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Kitakyushu, Japan. 15. Department of Disaster and Emergency Medicine, Kobe University Graduate School of Medicine, Kobe, Japan. 16. Emergency and Critical Care Medicine, Saga University Hospital, Saga, Japan. 17. Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan. 18. Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Fukushima, Japan. 19. Emergency & Critical Care Center, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan. 20. Advanced Medical Emergency & Critical Care Center, Yamaguchi University Hospital, Kawasaki, Japan. 21. Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan. 22. Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan. 23. Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan. 24. Advanced Critical Care Center, Aichi Medical University Hospital, Nagoya, Japan. 25. Advanced Emergency Medical Service Center, Kurume University Hospital, Fukuoka, Japan. 26. Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan. 27. Department of Trauma, Critical Care Medicine, and Burn Center, Japan Community Healthcare Organization Chukyo Hospital, Fukuoka, Japan. 28. Division of Acute and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Abstract
PURPOSE: Hospital services are reduced during off-hour such as nighttime or weekend. Investigations of the off-hour effect on initial management and outcomes in sepsis are very limited. Thus, we tested the hypothesis that patients who were diagnosed with severe sepsis during the nighttime or on non-business days had altered initial management and clinical outcomes. MATERIALS AND METHODS: Patients with severe sepsis from 59 ICUs between 2016 and 2017 were enrolled. The patients were categorized according to the diagnosis time or day and were then compared. The primary outcome was in-hospital mortality. RESULTS: One thousand one hundred and forty-eight patients were analyzed; 769 daytime patients, vs. 379 nighttime patients, and 791 business day patients vs. 357 non-business day patients. There were no significant differences in in-hospital mortality between either daytime and nighttime (24.4% vs. 21.4%, P = .27; nighttime, adjusted odds ratio [OR] 1.17, 95% confidence interval [CI], 0.87-1.59, P = .30) or between business and non-business days (22.9% vs. 24.6%, P = .55; non-business day, adjusted OR 0.85, 95% CI 0.60-1.22, P = .85). Time to antibiotics was significantly shorter in the nighttime (114 vs. 89 min, P = .0055). CONCLUSIONS: Nighttime and weekends were not associated with increased in-hospital mortality of severe sepsis.
PURPOSE: Hospital services are reduced during off-hour such as nighttime or weekend. Investigations of the off-hour effect on initial management and outcomes in sepsis are very limited. Thus, we tested the hypothesis that patients who were diagnosed with severe sepsis during the nighttime or on non-business days had altered initial management and clinical outcomes. MATERIALS AND METHODS:Patients with severe sepsis from 59 ICUs between 2016 and 2017 were enrolled. The patients were categorized according to the diagnosis time or day and were then compared. The primary outcome was in-hospital mortality. RESULTS: One thousand one hundred and forty-eight patients were analyzed; 769 daytime patients, vs. 379 nighttime patients, and 791 business day patients vs. 357 non-business day patients. There were no significant differences in in-hospital mortality between either daytime and nighttime (24.4% vs. 21.4%, P = .27; nighttime, adjusted odds ratio [OR] 1.17, 95% confidence interval [CI], 0.87-1.59, P = .30) or between business and non-business days (22.9% vs. 24.6%, P = .55; non-business day, adjusted OR 0.85, 95% CI 0.60-1.22, P = .85). Time to antibiotics was significantly shorter in the nighttime (114 vs. 89 min, P = .0055). CONCLUSIONS: Nighttime and weekends were not associated with increased in-hospital mortality of severe sepsis.
Authors: Je Sung You; Yoo Seok Park; Sung Phil Chung; Hye Sun Lee; Soyoung Jeon; Won Young Kim; Tae Gun Shin; You Hwan Jo; Gu Hyun Kang; Sung Hyuk Choi; Gil Joon Suh; Byuk Sung Ko; Kap Su Han; Jong Hwan Shin; Taeyoung Kong Journal: Crit Care Date: 2022-02-11 Impact factor: 9.097