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Traumatic Brain Injury Risks Higher on the Weekends

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Posted on August 9, 2013

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. 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. 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 discharge.
  • 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 a difference.”

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.

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