Does "off-hours" admission affect burn patient outcome?

Introduction: Previous critical care and cardiology studies find that critically ill patients have worse outcomes when admitted to the hospital during off-hours as compared to those admitted during weekdays. As severe burn is equally emergent we hypothesized that this disparity in outcomes would exist for burn patients as well. Study design: Secondary analysis of the National Trauma Data Bank (NTDB) version 7.1. The NTDB is a national registry of hospital admissions for traumatic injury administered by the American College of Surgeons. Setting: 700 trauma facilities nationwide contributing to the NTDB between 2002 and 2006. Subjects: All trauma patients included in the dataset with the injury mechanism of burn divided into "off-hours" admits (nights from 6 pm to 6 am and weekends) and weekday admits. Measures: Time and day of admission, demographics, ISS score, injury characteristics (±inhalational injury, TBSA, and full thickness injury), facility characteristics (number of burn beds, teaching status). Outcomes: Mortality as the primary outcome. Secondary outcomes include ICU length of stay (LOS), hospital length of stay. Data analysis: Descriptive statistics to summarize group characteristics, χ² and Student's t tests for bivariate analysis, multivariable linear and logistic regressions. Results: Of the 25,572 burn patients, 17,625 (68.9%) arrived during off-hours. There was no difference in ICU length of stay (LOS) (p = 0.233), hospital LOS (p = 0.82), or mortality (p = 0.546) for those admitted during off-hours compared with weekday admits. In multivariate analysis when controlling for age, gender, burn characteristics (inhalation injury, full thickness injury, and TBSA >30%), and hospital type, off-hours admission was not predictive of mortality (OR = 1.06, 95% CI 0.91-1.23). Conclusions: Contrary to studies in other critically ill patient populations, off-hours admission is not predictive of worse outcomes in burn patients.