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

Biswadev Mitra, Peter A Cameron, Mark C B Fitzgerald, Stephen Bernard, John Moloney, Dinesh Varma, Huyen Tran and Martin Keogh
Med J Aust 2014; 201 (10): 588-591. || doi: 10.5694/mja13.00235

Summary

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.

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  • Biswadev Mitra1
  • Peter A Cameron2
  • Mark C B Fitzgerald1
  • Stephen Bernard1
  • John Moloney1
  • Dinesh Varma1
  • Huyen Tran1
  • Martin Keogh1

  • 1 The Alfred Hospital, Melbourne, VIC.
  • 2 Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC.

Correspondence: biswadev.mitra@monash.edu

Competing interests:

No relevant disclosures.

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