Data included in the TraumaRegister DGU® are collected prospectively. The database of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie, DGU) was founded in 1993. The TraumaRegister DGU® is a multicenter database with the aim of pseudonymized and standardized documentation of severely injured patients. Data on transport methods, care entities and patient populations were objectively compared. The collection of data from the TR-DGU enabled the evaluation of multiple trauma patients treated in different trauma centers. We used TraumaRegister DGU® to evaluate the current demographic data and the timing of medical interventions in multiple trauma patients admitted during the day and at night. This study evaluated whether the time of day at which a multiple trauma patient arrived at the trauma center affected the timing of medical care during the first 24 h and the mortality rate. In this study, we evaluated novel data for different quality indicators of multiple trauma care during the night. Previous studies in emergency care have shown a higher mortality rate and longer hospital stay after patient admission during the night shift. Specific trauma care in the emergency room, the rapid performance of diagnostic procedures without delay and direct transfer to intensive care or the operating room determine the length of hospital stay and outcomes. The quality of multiple trauma care in the first 24 h is determined by the timeliness of making a diagnosis and initiating interventions and the time lost by waiting. Medical diagnostics such as X-rays and CT scans take longer because there are fewer radiology staff members available. Additionally, staff density is reduced during the night. Decreases in the cognitive and physical performance of medical staff during the night might cause delays and malpractice. Emergency care during the night can be complicated by medical errors, increased complications and less frequent use of aggressive interventions. In particular, presentation at night has been identified as a risk factor for poor outcomes in critically ill patients needing a prompt diagnosis and the timely implementation of interventions. Many multiple trauma patients arrive at the trauma center during the evening and night. Multiple trauma is one of the leading causes of death and disability worldwide, and severe injuries must be diagnosed and treated 24 h per day. Despite the differences in these factors, arrival at night did not have a negative effect on the outcome. The patient population and injury severity vary between the day and night with regard to age, injury pattern and trauma mechanism. Admission at night was not a predictor of a higher mortality rate. There were no differences in RISC II scores or mortality rates according to time period. There was no relevant difference in the Revised Injury Severity Classification II (RISC II) score or mortality rate between patients admitted during the day and at night. The outcome was also not affected by level of the trauma center. Time in the trauma department and time to an emergency operation were only marginally different. Resultsįewer patients were admitted during the night (6.00 pm–11.59 pm: 18.8% of the patients, 0.00–5.59 am: 4.6% of the patients) than during the day. Incidences, patient demographics, injury patterns, trauma center levels and trauma care times and outcomes were evaluated. All data were obtained from TraumaRegister DGU®. Methodsĭata from 58,939 multiple trauma patients from 2007 to 2017 were analyzed retrospectively. This study involved the analysis of a population of multiple trauma patients admitted at night and a comparison of various indicators of the quality of care at different admission times. Several studies have demonstrated worse outcomes and higher mortality in patients admitted at night. Optimal multiple trauma care should be continuously provided during the day and night.
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