Abstract
Mortality is higher for adults admitted to hospital and for babies born on weekends compared to weekdays. This study compares in-hospital mortality and in children admitted to hospital on weekends and weekdays. Details for all acute medical admissions to hospitals in Scotland for children aged ≤16 years between 1st January 2000 and 31st December 2013 were obtained. Death was linked to day of admission. There were 570,403 acute medical admissions and 334 children died, including 83 who died after an admission on Saturday or Sunday and 251 who died following admission between Monday and Friday. The adjusted odds ratio (aOR) for a child dying after admission on a weekend compared to weekday was 1.03 [95% CI 0.80 to 1.32]. The OR for a child admitted over the weekend requiring intensive care unit (ICU) or high dependency unit (HDU) care was 1.24 [1.16 to 1.32], but the absolute number of admissions to HDU and ICU per day were similar on weekends and weekdays. We see no evidence of increased in-hospital paediatric mortality after admission on a weekend. The increased risk for admission to ITU or HDU with more serious illness over weekends is explained by fewer less serious admissions.
Highlights
The 2015 Keogh report [1] has set the agenda for a “seven day service” in the NHS and is at least in part driven by several reports of increased mortality for adult patients admitted on weekends compared to weekdays,[2,3,4] and of increased neonatal mortality for those born on weekends. [5,6,7] One study, which focussed on data from admissions to 29 paediatric intensive care units in the UK and Eire, concluded that mortality after emergency admission on the weekend was not associated with increased mortality.[8]
Details of each hospital admission in Scotland between 1st January 2000 and 31st December 2013 for individuals aged up 16 years of age were provided by the Information Services Division (ISD) of the Scottish Government in January 2015
Details of differences in diagnoses made across days of the week are presented in the supplement (S1 File). We believe that this is the first whole-population study to compare in-hospital mortality between children admitted to hospital on a weekend or on a weekday
Summary
The 2015 Keogh report [1] has set the agenda for a “seven day service” in the NHS and is at least in part driven by several reports of increased mortality for adult patients admitted on weekends compared to weekdays,[2,3,4] and of increased neonatal mortality for those born on weekends. [5,6,7] One study, which focussed on data from admissions to 29 paediatric intensive care units in the UK and Eire, concluded that mortality after emergency admission on the weekend was not associated with increased mortality.[8]. [5,6,7] One study, which focussed on data from admissions to 29 paediatric intensive care units in the UK and Eire, concluded that mortality after emergency admission on the weekend was not associated with increased mortality.[8] Many thousands of children are admitted to hospital with acute medical conditions in the UK each day but it is not known whether mortality related to admission for this age group varies between weekday and weekend. The primary aim of this whole population study of acute medical paediatric admissions was to describe in–hospital mortality in children presenting on weekends compared to weekdays. Our principle hypothesis was that there will be increased in-hospital mortality for children
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