SGEM#253: Everybody’s Working on the Weekend

Date: April 17th, 2019 Reference: Little et al. Major trauma: Does weekend attendance increase 30-day mortality? Injury 2019 Guest Skeptic: Alison Armstrong is a Certified Emergency Nurse, Trauma Program Coordinator and TNCC Course Director. This was a special episode of the SGEM done live at the Talk Trauma 2019 Conference help in London, Ontario. Talk Trauma is a two-day conference for nurses, allied health and EMS professionals involved in providing care for the adult and paediatric trauma patient. Our philosophy for Talk Trauma is to have fun while learning so we put on a conference packed with useful tips for all trauma care providers but in a really fun way! It attracts participants from all over Ontario and even the US. To get the crowd warmed up for our nerdy structured critical appraisal we reviewed a paper by Dr. Esther Choo et al. The article was called "A lexicon for gender bias in academia and medicine: Mansplaining is the tip of the iceberg". It was published in the December 2018 edition of the BMJ.  Theme music is an important part of the SGEM. Alison picked the song "It's A Man's World"  by James Brown for this paper on gender bias in academia and medicine. Mansplaining is defined as explaining something in a condescending or patronizing way, typically to a woman. Alison picked out five of her favourite terms from the BMJ publication and presented them to the audience. This included: misteria, himpediment, hystereotyping, mutehism, and bromoteher. As a rural physician, I added one more term to the medical lexicon called "urbansplaining" You can down load a copy of the slides, watch the presentation on the SGEM Facebook page and get a PDF copy of Dr. Choo's article.  Case: A 52-year-old man presents to the emergency department via EMS after a motor vehicle collision while driving home from the city. It is 2am Saturday morning and the night shift has been busy. You suspect he has been drinking. He has a Glasgow Coma Scale (GCS) score of 13 and an Injury Severity Score (ISS) of 19. There is small frontal head laceration. He is complaining of some right sided chest wall pain and shortness of breath.  There is an obvious knee injury. While he is waiting to get imaging and laboratory tests done, he asks if he will be more likely to die because it’s a weekend? Background: We have busted many myths on the SGEM over the years. This have included the following medical myths: Myth: Epinephrine saves lives with good neurologic outcome in OHCA (SGEM#64 and SGEM#238) Myth: All buckle and greenstick fractures should be casted (SGEM#19) Myth: A vitamin C cocktail can cure sepsis based on an observational study (SGEM#173) Myth: Ketorolac 30mg IV is better than 10mg or 15mg IV for pain control (SGEM#174) Myth: OHCA patients need an endotracheal airway (SGEM#247) There are many other myths in medicine like that of the full moon effect (lunar effect). One large area of controversy is that of the “weekend effect”. This urban legend is that mortality rates go up when patients are admitted on the weekend vs. the weekdays. Clinical Question: Does the “weekend effect” exist (increased mortality) in a UK trauma centre? Reference: Little et al. Major trauma: Does weekend attendance increase 30-day mortality? Injury 2019 Population: Trauma patients presenting to the emergency department defined as Injury Severity Score greater than eight admitted between 2013 – 2015. Intervention: None Comparison: Weekday (Monday 00:00 to Friday 23:59) vs. weekend (Saturday 00:00 - Sunday 23:59). Outcome: Primary Outcome: Mortality by 30 days Secondary Outcomes: Age, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), mortality by days of the week, and mortality by 30 days on Friday 00:00 to Saturday 23:59 vs. Sunday 00:00 to Thursday 23:59. Authors’ Conclusions: “There is no significant difference in 30-day mortality when directly comparing weekday to weekend attend...