"After-hours" staffing of trauma centres and outcomes among patients presenting with acute traumatic coagulopathy

Objective: To examine the effect of the "after-hours" (18:00-07:00) model of trauma care on a high-risk subgroup patients presenting with acute traumatic coagulopathy (ATC). Design, participants and setting: Retrospective analysis of data from the Alfred Trauma Registry for patients with ATC presenting between 1 January 2006 and 31 December 2011. Main outcome measure: Mortality at hospital discharge, adjusted for potential confounders, describing the association between after-hours presentation and mortality. Results: There were 398 patients with ATC identified during the study period, of whom 197 (49.5%) presented after hours. Mortality among patients presenting after hours was 43.1%, significantly higher than among those presenting in hours (33.1%; P=0.04). Following adjustment for possible confounding variables of age, presenting Glasgow Coma Scale score, urgent surgery or angiography and initial base deficit, after-hours presentation was significantly associated with higher mortality at hospital discharge (adjusted odds ratio, 1.77; 95% Cl, 1.10-2.87). Conclusion: The after-hours model of care was associated with worse outcomes among some of the most critically ill trauma patients. Standardising patient reception at major trauma centres to ensure a consistent level of care across all hours of the day may improve outcomes among patients who have had a severe injury.