"After-hours" staffing of trauma centres and outcomes among patients presenting with acute traumatic coagulopathy

Research output: Contribution to journalArticleResearchpeer-review

Abstract

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.
Original languageEnglish
Pages (from-to)588 - 591
Number of pages4
JournalMedical Journal of Australia
Volume201
Issue number10
DOIs
Publication statusPublished - 17 Nov 2014

Cite this

@article{83b64d77b0664b9ca6e0c80a77c80ee8,
title = "{"}After-hours{"} staffing of trauma centres and outcomes among patients presenting with acute traumatic coagulopathy",
abstract = "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.",
author = "Biswadev Mitra and Cameron, {Peter A} and Fitzgerald, {Mark C B} and Stephen Bernard and John Moloney and Dinesh Varma and Tran, {Huyen A} and Keogh, {Martin J}",
year = "2014",
month = "11",
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doi = "10.5694/mja13.00235",
language = "English",
volume = "201",
pages = "588 -- 591",
journal = "Medical Journal of Australia",
issn = "0025-729X",
publisher = "AMPCo",
number = "10",

}

TY - JOUR

T1 - "After-hours" staffing of trauma centres and outcomes among patients presenting with acute traumatic coagulopathy

AU - Mitra, Biswadev

AU - Cameron, Peter A

AU - Fitzgerald, Mark C B

AU - Bernard, Stephen

AU - Moloney, John

AU - Varma, Dinesh

AU - Tran, Huyen A

AU - Keogh, Martin J

PY - 2014/11/17

Y1 - 2014/11/17

N2 - 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.

AB - 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.

UR - https://www.mja.com.au.ezproxy.lib.monash.edu.au/system/files/issues/201_10/mit00235.pdf

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DO - 10.5694/mja13.00235

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