• Vol. 37 No. 5, 390–396
  • 15 May 2008

Outcome of Severe Head Injured Patients Admitted to Intensive Care During Weekday Shifts Compared to Nights and Weekends

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ABSTRACT

Introduction: Some studies have demonstrated an increased risk of death for patients admitted at nights or during weekends. This study was undertaken to investigate the demographic profile, medical interventions and outcome of severe head injury patients stratified according to day and time of admission to a specialised neurosciences intensive care unit (NICU).

Materials and Methods: A retrospective study using a prospectively maintained severe head injury database in a tertiary hospital. Admissions to the NICU were grouped into weekdays, weeknights and weekends. A comparison of patients admitted during the day and night hours were also made.

Results: A total of 838 severe head injury patients admitted to NICU were included in the study, of which 263 were admitted on weekdays, 327 on weeknights and 248 on weekends. More patients were admitted during the night (496) compared to during the day (342). There were no significant differences in the demographic profile, mechanism of injury, severity of injury, need for neurosurgical intervention, and duration of mechanical ventilation, intensive care unit (ICU) stay and mortality associated with day and time of admission. In multivariate analyses controlling for confounding factors, no statistically significant difference in ICU mortality was found with the day and time of admission.

Conclusions: There were more severe head injury patients admitted to ICU at night and on weekends, with no significant difference in demographic profile, types of injuries, need for neurosurgical interventions and duration of ICU stay and mortality in a specialised NICU with adequate staffing and requisite diagnostic and therapeutic modalities available.


Recognising that severe head injury is a major health problem with significant mortality and morbidity, numerous epidemiological and outcome studies have been conducted in order to devise effective preventive measures and, allocation of resources, and for the prognostication for healthcare planning. Patients presenting with severe head injury [defined as Glasgow coma scale (GCS) ≤8] are at the highest risk for the development of intracranial hypertension and thus require admission to the intensive care unit (ICU) for close monitoring.

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