Is there a weekend effect on mortality rate and outcome for moderate and severe traumatic brain injury? A population-based, observational cohort study

Joakim Stray Andreassen; Kenneth Thorsen; Kjetil Søreide; David Werner; Clemens Weber

doi:10.1016/j.bas.2022.101699

Is there a weekend effect on mortality rate and outcome for moderate and severe traumatic brain injury? A population-based, observational cohort study

Brain Spine. 2022 Dec 1:2:101699. doi: 10.1016/j.bas.2022.101699. eCollection 2022.

Authors

Joakim Stray Andreassen¹, Kenneth Thorsen^{2

3

4}, Kjetil Søreide^{2

3}, David Werner⁵, Clemens Weber^{5

6}

Affiliations

¹ Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway.
² Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
³ Department of Clinical Medicine, The Faculty of Medicine, University of Bergen, Bergen, Norway.
⁴ Section for Traumatology, Surgical Clinic, Stavanger University Hospital, Stavanger, Norway.
⁵ Department of Neurosurgery, Stavanger University Hospital, Stavanger, Norway.
⁶ Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway.

Abstract

Purpose: The aim of the study was to analyse patient and injury characteristics and the effects of weekend admissions on mortality rate and outcome after moderate and severe traumatic brain injuries.

Methods: This is an observational cohort study based on data from a prospectively maintained regional trauma registry in South Western Norway. Patients with moderate and severe traumatic brain injury admitted between January 1st, 2004 and December 31st, 2019 were included in this study.

Results: During the study period 688 patients were included in the study with similar distribution between moderate (n = 318) and severe (n = 370) traumatic brain injury. Mortality rate was 46% in severe and 13% in moderate traumatic brain injury. Two hundred and thirty-one (34%) patients were admitted during weekends. Patients admitted during weekends were significantly younger (median age (IQR) 32.0 (25.5-67.0) vs 47.0 (20.0-55.0), p < 0.001). Pre-injury ASA 1 was significantly more common in patients admitted during weekends (n = 146, 64%, p = 0.001) while ASA 3 showed significance during weekdays compared to weekends (n = 101, 22%, p = 0.013). On binominal logistic regression analysis mortality rate was significantly higher with older age (OR 1.03, 95% CI for OR 1.02-1.04, p < 0.001) and increasing TBI severity (OR 7.08, 95% CI for OR 4.67-10.73, p < 0.001).

Conclusions: Mortality rate and poor clinical outcome remain high in severe traumatic brain injury. While a higher number of patients are admitted during the weekend, mortality rate does not differ from weekday admissions.

Keywords: Epidemiology; Mortality; Traumatic brain injury; Weekend.