Most cases of Traumatic Brain Injuries (TBI) result from car accidents,
recreational activities, and falls. Falls pose a much greater risk to
the elderly, as susceptibility to fractures and brain injuries is significantly
higher for those ages 65 and above. A recent study by John Hopkins University
also found that seniors above the age of 65 made up a disproportionately
large division of patients admitted for TBI’s.
Historically, emergency room data shows that weekends are typically correlated
with a higher concentration of admissions for traumatic brain injuries.
Different factors apply when comparing brain injuries resulting from accidents
in the general public to seniors incurring TBI’s from falls in nursing
homes and assisted care facilities. Even when we account for the higher
vulnerability of seniors, and how their rate of injury does not respond
to the same variables that might be identified for the general public,
weekends still capture a higher incidence of head injuries.
Two Causes of Increased Head Injury Risk in the General Public
1. Weekend Socializing: Nightclub outings, barbecues, and sponsored events typically take place
on weekends, making alcohol readily available in a highly social context.
Public intoxication increases the general likelihood of falls, altercations,
and car accidents occurring. Predictably, this also corresponds to a spike
in head injuries.
2. Youth Sports Activities & Children at Play: TBI’s are the leading annual cause of death and disability among
children and adolescents across the US. Many youth sports leagues and
recreational organizations host events each weekend. Additionally, children
are home from school, where they are under closer supervision, and are
at play in neighborhoods, parks, and backyard swimming pools. Each activity
can pose its own heightened risk of brain injury.
The “Weekend Effect” and Brain Injuries in Seniors
Medical studies have also uncovered an odd statistic in relation to weekend
hospital admissions for traumatic brain injuries among the elderly. The
vast majority of brain injuries in seniors are fall-related. However,
studies have actually revealed a higher risk of mortality in seniors admitted
over the weekend when compared with weekday admissions. The trend has
been dubbed “the weekend effect”.
Although marginal weekend effect patterns have appeared in relation to
other injuries, statistics were the most pronounced in cases of traumatic
brain injuries in patients age 65 or older.
- Seniors admitted for a TBI on a weekend are 14% more likely to die before
- Seniors admitted on the weekend had fewer co-morbidity factors and less
severe head injuries, yet mortality probability rates were still elevated.
- Greater age revealed a direct correlation with increased risk of death
– patients age 85 and over were twice as likely (28%) to die before
discharge when compared with the 65 to 84 age group.
Staffing Gaps Suspected as One Cause behind the “Weekend Effect”
The mortality rate study was led by John Hopkins University School of Medicine
epidemiologist, Dr. Eric B. Schneider. Schneider speculates that a primary
reason behind the weekend effect is a disparity in staffing levels. Schneider explains:
“Neurosurgery, or other invasive specialties like invasive radiology,
may not have the same staffing on weekends. During the week, there very
well may be a neurosurgeon in the hospital, but on the weekend, the neurosurgeon
may be on the golf course. He has a pager and will come in, but instead
of being there in 10 minutes, he is there in an hour, and that could make
Schneider also pointed out that there is not an apparent “weekend
effect” in head injury mortality rates among centers specializing
in head trauma or stroke care. “This may be a function of staffing
because these facilities have staffing on weekends that is not greatly
different from that on weekdays,” said Schneider.
Schneider’s report was published online in the Journal of Surgical
Research on July 9th, 2012. It is unknown whether any hospitals have re-evaluated
their neurological staffing plans for weekend coverage. Nursing-home care
providers and adults caring for their aging parents may wish to note the
location of the nearest trauma care or stroke treatment center so that
they may devise an emergency plan in case an accident occurs over the weekend.