Background
Injuries are the leading cause of death in the United States for children between the ages of 1 and 19 years. Weekend hospital admission has been associated with poor outcomes and higher mortality rates for a variety of diseases. We examined the impact of weekend versus weekday admission on in-hospital morbidity and case-fatality rates for pediatric trauma patients.
Methods
We performed a cross-sectional analysis on the 2016 Kids’ Inpatient Database. The study population included pediatric trauma patients under the age of 19 years which were stratified by weekend vs weekday admission. Weightings were used to produce national estimates. Multiple logistic regression analyses were performed to assess the odds of in-hospital complications and death after adjusting for a variety of potentially confounding demographic and clinical factors.
Results
Patients admitted on a weekend were older, more frequently male, White, and privately insured. Weekend admissions had a higher Injury Severity Score (6.7 vs 5.4, p<0.001), as well as higher rate of intensive care unit (ICU) admission (8.5% vs 7.1%, p<0.001) and in-hospital case-fatality rate (1.3% vs 1.1%, p=0.003), but lower rate of in-hospital complications (6.1% vs 6.8%, p<0.001). Unadjusted logistic regression demonstrated that weekend admission was associated with higher odds of in-hospital death as compared to weekday admission (odds ratio 1.20, 95% confidence interval [CI] 1.07 – 1.35), but in the multivariable adjusted model this was no longer statistically significant (adjusted odds ratio [aOR] 1.06, 95% CI 0.94 – 1.20). Weekend admission was associated with lower odds of in-hospital complications (aOR 0.90, 95% CI 0.86 - 0.95), but higher odds of ICU admission (aOR 1.12, 95% CI 1.06 – 1.18).
Conclusions
Weekend admission in pediatric trauma is associated with higher odds of ICU admission. There does not appear to be an association between weekend admission and odds of in-hospital death, however it may be associated with lower odds of in-hospital complications.
| Identifer | oai:union.ndltd.org:umassmed.edu/oai:escholarship.umassmed.edu:gsbs_diss-2139 |
| Date | 19 April 2021 |
| Creators | Hazeltine, Max D. |
| Publisher | eScholarship@UMassChan |
| Source Sets | University of Massachusetts Medical School |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | Morningside Graduate School of Biomedical Sciences Dissertations and Theses |
| Rights | Copyright is held by the author, with all rights reserved., select |
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