Association between hospital arrival time/day and mortality in pediatric patients with severe trauma: a nationwide retrospective observational study in Japan.

Abstract

This study aimed to evaluate the association between hospital arrival time/day and mortality in pediatric patients with severe trauma. This retrospective observational study was conducted using data retrieved from the Japan Trauma Data Bank from January 2004 to May 2019. Patients younger than 18 years and with an Injury Severity Score of 16 or higher were included. Patients' hospital arrival time was categorized into daytime (9:00 am to 4:59 pm) and nighttime (5:00 pm to 8:59 am), and hospital arrival day was categorized into weekdays (Monday to Friday, except for national holidays) and weekends/holidays (Saturday, Sunday, and national holidays). The main outcome was in-hospital mortality. Multiple imputation was used to address missing values. Subsequently, inverse probability of treatment weighting was applied to compare in-hospital mortality rates between the two sets of groups: (1) nighttime and daytime arrival groups and (2) weekend/holiday and weekday arrival groups. Overall, 6562 patients were included in this study, and the crude in-hospital mortality rate was 6.8%. The odds of in-hospital mortality were significantly higher in the nighttime arrival group than in the daytime arrival group (adjusted odds ratio [aOR], 1.35; 95% confidence interval [CI], 1.09-1.68). In contrast, no significant difference was observed between the weekend/holiday arrival group and the weekday arrival group (aOR, 0.95; 95% CI, 0.79-1.13). Nighttime hospital arrival was associated with higher odds of in-hospital mortality in pediatric patients with severe trauma but weekend/holiday arrival was not.