Does "off-hours" admission affect burn patient outcome?

Abstract

Previous critical care and cardiology studies find that critically ill patients have worse outcomes when admitted to the hospital during off-hours as compared to those admitted during weekdays. As severe burn is equally emergent we hypothesized that this disparity in outcomes would exist for burn patients as well. Secondary analysis of the National Trauma Data Bank (NTDB) version 7.1. The NTDB is a national registry of hospital admissions for traumatic injury administered by the American College of Surgeons. 700 trauma facilities nationwide contributing to the NTDB between 2002 and 2006. All trauma patients included in the dataset with the injury mechanism of burn divided into "off-hours" admits (nights from 6pm to 6am and weekends) and weekday admits. Time and day of admission, demographics, ISS score, injury characteristics (+/-inhalational injury, TBSA, and full thickness injury), facility characteristics (number of burn beds, teaching status). Mortality as the primary outcome. Secondary outcomes include ICU length of stay (LOS), hospital length of stay. Descriptive statistics to summarize group characteristics, chi(2) and Student's t tests for bivariate analysis, multivariable linear and logistic regressions. Of the 25,572 burn patients, 17,625 (68.9%) arrived during off-hours. There was no difference in ICU length of stay (LOS) (p=0.233), hospital LOS (p=0.82), or mortality (p=0.546) for those admitted during off-hours compared with weekday admits. In multivariate analysis when controlling for age, gender, burn characteristics (inhalation injury, full thickness injury, and TBSA >30%), and hospital type, off-hours admission was not predictive of mortality (OR=1.06, 95% CI 0.91-1.23). Contrary to studies in other critically ill patient populations, off-hours admission is not predictive of worse outcomes in burn patients.