‘Weekend Effect’ Absent in England’s Major Trauma Centres

RESEARCHERS find no ‘weekend effect’ in the care given to patients admitted to major trauma centres (MTCs) across England. The ‘weekend effect’ is a controversial finding from previous research that has shown worse outcomes, including increased mortality, for patients admitted to various care settings at the weekend compared to those on other days. The cause of the effect is not clear, which can be particularly troubling when trying to mitigate its presence within emergency care settings.

In this recent study led by David Metcalfe at the University of Oxford, Oxford, UK, no evidence was found of increased mortality for patients admitted to an MTC at the weekend, or at night. The team also found no association between weekend or night admission and increased lengths of stay or worse Glasgow Outcome Score (GOS). The GOS is a five-point disability measurement that ranges from ‘death’ to ‘good recovery’, meaning a patient will return to normal life.

Mr Metcalfe and the team measured the outcomes of trauma patients using the Trauma Audit & Research Network (TARN). TARN is a national trauma registry that includes all 22 hospitals in England that manage major trauma services. The team observed 49,070 cases submitted to TARN. A total of 13,241 patients were admitted to an MTC during the day. Day-time was defined as being between the hours of 08:00 am and 17:00 pm.

The team found no significant differences in a GOS score of ‘good recovery’ between weekday admissions (9,394; 63.9%) and weekend admissions (3,847; 64.1%) during the day. They also measured near-identical results for a GOS score of ‘good recovery’ among the 18,076 patients admitted at night, or after the hours of 17:00 pm until 08:00 am. The team also found that mortality outcomes were similar among trauma patients on the TARN registry. In the day-time, 1,255 (8.5%) of patients admitted to an MTC on a weekday died, compared to the 501 (8.4%) who died on a weekend. Similar results were observed for the 2,313 patients admitted during the night.

The authors of the study concluded that no evidence had been found of a ‘weekend effect’ for patients treated within English MTCs. The authors felt these findings could be explained by the trauma centres in England being adequately prepared to provide a consistent service each day and at all hours. Another potential explanation was that the weekend effect has only even been a ‘coding artefact’ created by systematic miscoding in administrative datasets. Therefore, the artefact could have been removed in this study, explained the authors, because of their use of high-quality clinical data taken from the TARN registry.

Jack Redden, Reporter