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The greater death rate for hospitalized weekend head trauma patients occurs even though their injuries are less severe and they have fewer other illnesses than their weekday counterparts.

A so-called “weekend effect” on patient outcomes has previously been well-documented for heart attack, stroke and aneurism treatment. The new research, in the form of a Johns Hopkins review of more than 38,000 patient records, extends the finding to head trauma care.

A report, published online in the Journal of Surgical Research, suggests that reduced staffing and lack of ready access to specialists may be factors in the higher weekend death rates after head injury.

“There isn’t a medical reason for worse results on weekends,” says study leader Eric B. Schneider, an epidemiologist at Johns Hopkins University School of Medicine’s Center for Surgical Trials and Outcomes Research. “It’s more likely a difference in how hospitals operate over the weekend as opposed to during the week, meaning that there may be a real opportunity for hospitals to change how they operate and save lives.”

Approximately 1.4 million Americans suffer head trauma that results in a hospital visit each year, the researchers say, and more than 50,000 die annually as a result of their injuries. An estimated 235,000 require inpatient care.

Unlike other forms of trauma that disproportionately affect young people, head trauma and mortality associated with it increase as people age, Schneider says. The highest rates of hospitalization and death for such injuries occur in people over 75.

Using 2006-2008 data from the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample, Schneider and his colleagues examined records from 38,675 people between 65 and 89 admitted to U.S. hospitals with head trauma; 9,937 of the admissions (or 25.6 percent) occurred on weekends.

The researchers found that weekend patients were 14 percent more likely to die from their injuries than weekday patients, even after accounting for other factors. The age of patients admitted on weekends was similar to those admitted on weekdays, and weekend patients had less severe head trauma and were less sick with other illnesses.

Cost of care, as measured by charges billed, was roughly the same, suggesting that weekend and weekday patients got similar treatments. Differences in the timing of treatments could not, however, be examined in the available data.

Patients in the study were treated at trauma centers, teaching hospitals and community hospitals, but the researchers could not tell from the available data which type of facility saw which patient. Other research, however, has found a diminished weekend effect in patients taken to Level 1 trauma centers, where highly specialized staff is available 24 hours a day, seven days a week.

Schneider speculates that in addition to having fewer experienced doctors and nurses working on weekends, some hospitals may also experience delays in getting specialists such as neurosurgeons to the hospital on Saturdays and Sundays.

Schneider says one obvious solution is to staff every hospital on weekends at the same optimal level as weekdays, which he acknowledges may be impractical and too expensive. Another more practical approach, he says, might be for emergency medical personnel to transport older patients with head injuries directly to the nearest trauma center, bypassing closer facilities that cannot provide that level of care.

More news from Johns Hopkins University: http://releases.jhu.edu