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Effects of time of hospital admission on outcomes after severe traumatic brain injury in Austria

Effekt des Zeitpunkts der Aufnahme im Krankenhaus auf das Behandlungsergebnis nach schwerem Schädelhirntrauma in Österreich

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Summary

Background

The goal of this study was to compare outcomes of patients with severe traumatic brain injury (TBI) who had been admitted either during workdays from 7 a.m. to 7 p.m. (“regular service”) or during any other time (“on-call service”).

Material and methods

Between March 2002 and April 2012, 17 Austrian centers enrolled TBI patients into two observational studies that focused on effects of guideline compliance (n = 400) and on prehospital and early hospital management (n = 777), respectively. Data on trauma severity, clinical status, treatment, and outcomes were collected prospectively. All patients with severe TBI (Glasgow Coma Scale score < 9) were selected for this analysis. Secondary transfers and patients with unsurvivable injuries were excluded. The International Mission for Prognosis and Analysis of Clinical Trials in TBI core model was used to estimate probabilities of hospital death and unfavorable long-term outcome (Glasgow Outcome Scale score < 4). Based on time of arrival, patients were assigned to groups “regular service” or “on-call service.”

Results

Data from 852 patients were analyzed (413 “regular,” 439 “on-call service”). “On-call” patients were younger (45 vs. 51 years, P < 0.001) and had a higher rate of alcohol intoxication (41 vs. 11 %, P < 0.001). Trauma severity was comparable; the probabilities of death and unfavorable outcome were identical. There were no differences regarding computed tomography findings or treatment. Hospital mortality (24 vs. 28 %, P = 0.191) and rate of patients with unfavorable outcome at 6 months (43 vs. 48 %, P = 0.143) were comparable.

Conclusions

In Austria, the time of hospital admission has no influence on outcomes after severe TBI.

Zusammenfassung

Grundlagen

Das Ziel dieser Studie war, die Behandlungsergebnisse von Patienten mit schwerem Schädelhirntrauma (SHT) zu vergleichen, die entweder an Werktagen zwischen 07.00 und 19.00 Uhr (“regulärer Dienst”; „RD“) oder zu irgendeiner anderen Zeit (“Bereitschaftsdienst“, „BD“) eingeliefert wurden.

Methodik

Zwischen 3/2002 und 4/2012 rekrutierten 17 österreichische Zentren Patienten mit SHT für 2 Beobachtungsstudien, die den Effekt einer Richtlinien-konformen Behandlung (n = 400) bzw. die Ergebnisse einer besseren Erstversorgung (n = 777) untersuchten. Angaben zu Verletzungsschwere, klinischem Status, Therapie und Behandlungsergebnis wurden prospektiv erhoben. Alle Patienten mit schwerem SHT (Glasgow Coma Scale score < 9) wurden für diese Analyse ausgewählt. Sekundäre Transferierungen und Patienten mit nicht überlebbaren Verletzungen wurden exkludiert. Das IMPACT Core Model wurde verwendet, um die Wahrscheinlichkeit von Tod im Krankenhaus und von ungünstigem Langzeitergebnis (definiert als Glasgow Outcome Scale score < 4 nach 6 Monaten) abzuschätzen. Je nach Zeitpunkt der Einlieferung wurden die Patienten der Gruppe „RD“ oder „BD“ zugeteilt. Demografische Daten, Verletzungsschwere, Therapie und Behandlungsergebnisse wurden mittels Chi2-Test, T-Test, und logistischer Regression verglichen.

Ergebnisse

852 Datensätze waren verfügbar (413 “RD”, 439 “BD”). “BD”-Patienten waren jünger (45 vs. 51 Jahre, P < 0.001) und waren häufiger alkoholisiert (41 vs. 11 %, P < 0.001). Die Verletzungsschwere war vergleichbar, die Wahrscheinlichkeiten von Tod und von ungünstigem Behandlungsergebnis waren identisch. Es fanden sich keine Unterschiede hinsichtlich CT-Diagnosen und Behandlung. Spitalsmortalität (24 vs. 28 %, P = 0.191) und Prozentsatz der Patienten mit ungünstigem Langzeitergebnis (43 vs. 48 %, P = 0.143) waren vergleichbar.

Schlussfolgerungen

In Österreich hat der Zeitpunkt der Einlieferung ins Krankenhaus keinen signifikanten Einfluss auf die Behandlungsergebnisse von Patienten mit schwerem SHT.

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Acknowledgments

We are very grateful to the investigators from the participating centers who enrolled patients and collected data: H. Artmann MD (Schwarzach), N. Bauer MD (Linz UKH), F. Botha MD (Linz WJ), F. Chmeliczek MD (Salzburg LKA), G. Clarici MD (Graz Uni), D. Csomor MD (Wr. Neustadt), R. Folie MD (Feldkirch), R. Germann MD, PhD (Feldkirch), F. Gruber MD (Linz AKH), H-D. Gulle MD (Klagenfurt), T. Haidacher MD (Graz UKH), G. Herzer MD (Wr. Neustadt), P. Hohenauer MD (Salzburg LKA), A. Hüblauer MD (Horn), J. Lanner MD (Salzburg UKH), V. Lorenz MD (Wien UKH XII), C. Mirth MD (St. Pölten), W. Mitterndorfer MD (Linz AKH), W. Moser MD (Klagenfurt), H. Schmied MD (Amstetten), K-H Stadlbauer MD, PhD (Innsbruck), H. Steltzer MD, PhD (Wien UKH XII), Ernst Trampitsch MD (Klagenfurt), A. Waltensdorfer MD (Graz Uni), A. Zechner MD (Klagenfurt). We are also grateful to researchers from INRO: Ingrid Wilbacher PhD collected data during the first project; Ivan Janciak PhD developed and managed the databases used for both projects.

Funding

The data used for this study was collected for a project funded by the Austrian Worker’s Compensation Board (AUVA; FK 33/2003) and by the “Jubilee Fund” of the Austrian National Bank (Project No. 8987), and for a project funded by the Ministry of Health (Contract Oct. 15, 2008) and the AUVA (FK 11/2008, FK 11/2010, FK 09/12). INRO is supported by an annual grant from Mrs. Ala Auersperg-Isham and Mr. Ralph Isham, and by small donations from various sources.

Conflicts of interest

The authors do not have any conflicts of interest. This study has not been presented anywhere.

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Authors and Affiliations

  1. Department of Anesthesia and Intensive Care Medicine, Trauma Hospital “Lorenz Boehler”, Donaueschingenstrasse 13, 1200, Vienna, Austria

    Walter Mauritz MD, PhD

  2. International Neurotrauma Research Organization (INRO), Vienna, Austria

    Walter Mauritz MD, PhD,  Alexandra Brazinova MD, PhD, MPH, Marek Majdan PhD, Veronika Rehorcikova MSc & Johannes Leitgeb MD

  3. Department of Public Health, Faculty of Health and Social Services, Trnava University, Slovak Republic, Austria

    Alexandra Brazinova MD, PhD, MPH, Marek Majdan PhD & Veronika Rehorcikova MSc

  4. Department of Traumatology, Medical University of Vienna, Vienna, Austria

    Johannes Leitgeb MD

Authors
  1. Walter Mauritz MD, PhD
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  2. Alexandra Brazinova MD, PhD, MPH
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  3. Marek Majdan PhD
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  4. Veronika Rehorcikova MSc
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  5. Johannes Leitgeb MD
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Corresponding author

Correspondence to Walter Mauritz MD, PhD.

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Mauritz, W., Brazinova, A., Majdan, M. et al. Effects of time of hospital admission on outcomes after severe traumatic brain injury in Austria. Wien Klin Wochenschr 126, 278–285 (2014). https://doi.org/10.1007/s00508-014-0521-9

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  • DOI: https://doi.org/10.1007/s00508-014-0521-9

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