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The off-hour effect on trauma patients requiring subspecialty intervention at a community hospital in Japan: a retrospective cohort study

Overview of attention for article published in Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, February 2015
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Title
The off-hour effect on trauma patients requiring subspecialty intervention at a community hospital in Japan: a retrospective cohort study
Published in
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, February 2015
DOI 10.1186/s13049-015-0095-1
Pubmed ID
Authors

Yuko Ono, Tokiya Ishida, Yudai Iwasaki, Yutaka Kawakami, Ryota Inokuchi, Choichiro Tase, Kazuaki Shinohara

Abstract

Because most community hospitals in Japan do not maintain 24-h availability of in-house anesthesiologists, surgeons, and interventional radiologists, staffing dramatically declines during off hours. It is unclear whether, in such under-resourced hospitals, trauma patients presenting during off hours and requiring subspecialty intervention have worse outcomes than those who present during business hours. This was a retrospective cohort study at a community hospital in Japan. Participants were all injured patients requiring emergency trauma surgery or transarterial embolization who presented from January 2002 to December 2013. We investigated whether outcomes of these patients differed between business hours (8:01 AM to 6:00 PM weekdays) and off hours (6:01 PM to 8:00 AM weekdays plus all weekend hours). The primary outcome measure was mortality rate, and the secondary outcome measures were duration of emergency room (ER) stay; unexpected death (death/probability of survival > 0.5); and adverse events occurring in the ER. We adjusted for potential confounders of age, sex, Injury Severity Score (ISS), Revised Trauma Score, presentation phase (2002-2005, 2006-2009, and 2010-2013), Charlson Comorbidity Index, and injury type (blunt or penetrating) using logistic regression models. Of the 805 patients included, 379 (47.1%) presented during business hours and 426 (52.9%) during off hours. Off-hours presentation was associated with longer ER stays for patients with systolic blood pressure < 90 mmHg on admission (p = 0.021), ISS >15 (p = 0.047), and pelvic fracture requiring transarterial embolization (p < 0.001). Off-hours presentation was also associated with increased risk of adverse events in the ER (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.1-2.7, p = 0.020). After adjustment for confounders, an increased risk of adverse events (OR 1.6, 95% CI 1.1-2.7, p = 0.049) persisted, but no differences were detected in mortality (p = 0.80) and unexpected death (p = 0.44) between off hours and business hours. At a community hospital in Japan, presentation during off hours was associated with a longer ER stay for severely injured patients and increased risk of adverse events in the ER. However, these disadvantages did not impact mortality or unexpected outcome.

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Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 44 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 44 100%

Demographic breakdown

Readers by professional status Count As %
Researcher 8 18%
Other 6 14%
Student > Master 6 14%
Student > Bachelor 4 9%
Student > Ph. D. Student 4 9%
Other 7 16%
Unknown 9 20%
Readers by discipline Count As %
Medicine and Dentistry 23 52%
Nursing and Health Professions 4 9%
Psychology 2 5%
Mathematics 1 2%
Environmental Science 1 2%
Other 3 7%
Unknown 10 23%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 20 September 2015.
All research outputs
#18,427,608
of 22,829,083 outputs
Outputs from Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
#1,161
of 1,257 outputs
Outputs of similar age
#260,692
of 357,511 outputs
Outputs of similar age from Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
#20
of 20 outputs
Altmetric has tracked 22,829,083 research outputs across all sources so far. This one is in the 11th percentile – i.e., 11% of other outputs scored the same or lower than it.
So far Altmetric has tracked 1,257 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 10.2. This one is in the 3rd percentile – i.e., 3% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 357,511 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 15th percentile – i.e., 15% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 20 others from the same source and published within six weeks on either side of this one. This one is in the 1st percentile – i.e., 1% of its contemporaries scored the same or lower than it.