A Johns Hopkins study has found that the elderly who suffer major head trauma during a weekend are more likely to die of their injuries than those similarly hurt, but hospitalized during the week,” even if their injuries are less severe and they have fewer other illnesses than their weekday counterparts,” the school said in a press release.
Johns Hopkins came to its conclusion about the so-called “weekend effect” after reviewing more than 38,000 patient records.
In its press release, the university said that the so-called “weekend effect” on patient outcomes has been documented in cases of heart attack, stroke and aneurism treatment, and now appears to be issue in head-trauma, too.”
A report on the study was published online in the Journal of Surgical Research, and the belief is that reduced staffing on weekends, as well as a lack of ready access to specialists, are some of the reasons for higher weekend death rates after head injury.
“There isn’t a medical reason for worse results on weekends,” study leader Eric Schneider, an epidemiologist at the Johns Hopkins University School of Medicine’s Center for Surgical Trials and Outcomes Research, said in a statement. “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.”
About 1.4 million Americans sustain head trauma that results in a hospital visit each year, according to the John Hopkins’ researchers. More than 50,000 die annually as a result of their injuries, and an estimated 235,000 require inpatient care.
According to Schneider, head trauma and mortality associated with it increase as people age, with the highest rates of hospitalization and death for such injuries occurring in people over 75.
Overall, the scientists determined that weekend patients were 14 percent more likely to die from their injuries than weekday patients, even after accounting for other factors. For example, the ages of patients admitted on weekends were similar to those admitted on weekdays, and weekend patients had less severe head trauma and were less sick with other illnesses than weekday admissions, according to the press release.
Cost of care, measured as charges to patients, were about the same, suggesting that weekend and weekday patients got similar treatments, But researchers admitted that differences in the timing of treatments could not be examined in the available data.
The patients in the study were evaluated and treated at trauma centers, teaching hospitals and community hospitals, but the researchers could not tell from the available data which type of facility saw which patient.
However, other research has found a diminished weekend effect in patients taken to Level 1 trauma centers, where highly specialized staff is available 24 hours a day, seven days a week, according to the press release. The Johns Hopkins Hospital is a Level 1 trauma center.
In addition to having fewer experienced doctors and nurses working on weekends, some hospitals may also experience delays in getting specialists such as neurosurgeons to the hospital on Saturdays and Sundays, according to Schneider.
One way to address the issue would be for hospital to have the same optimal staffing on weekends s weekdays. But Schneider acknowledged that would be impractical and too expensive.
He came up with a more realistic solution: That emergency medical personnel to transport older patients with head injuries directly to the nearest trauma center, and bypass closer facilities that cannot provide that level of care.
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