Nighttime and non-business days are not associated with increased risk of in-hospital mortality in patients with severe sepsis in intensive care units in Japan: The JAAM FORECAST study
Nighttime and non-business days are not associated with increased risk of in-hospital mortality in patients with severe sepsis in intensive care units in Japan: The JAAM FORECAST study
复制标题
DOI：
10.1016/j.jcrc.2019.04.021
复制
发表时间：
2019-08-01
影响因子：
3.7
通讯作者：
Gando, Satoshi
中科院分区：
文献类型：
--
作者：
Matsumura, Yosuke;Nakada, Taka-aki;Gando, Satoshi
目的：减少非工作时间（如夜间或周末）的医院服务。关于非工作时间对败血症初始治疗和结局影响的研究非常有限。因此，我们测试的假设，即在夜间或非工作日被诊断为严重脓毒症的患者改变了初始管理和临床outcomes.Materials和方法：从2016年和2017年之间的59个ICU严重脓毒症患者入组。根据诊断时间或日期对患者进行分类，然后进行比较。主要结果是院内死亡率。结果：分析了1148例患者：769例白天患者，379例夜间患者，791例工作日患者，357例非工作日患者。日间和夜间住院死亡率无显著差异（24.4% vs. 21.4%，P = 0.27;夜间，校正比值比[OR] 1.17，95%置信区间[CI]，0.87-1.59，P = 0.30）或工作日和非工作日之间（22.9% vs. 24.6%，P = .55;非工作日，调整后OR 0.85，95% CI 0.60-1.22，P = .85）。夜间使用抗生素的时间显著缩短（114 vs. 89 min，P = 0.0055）。结论：夜间和周末与严重脓毒症的院内死亡率增加无关。(C)2019爱思唯尔公司All rights reserved.
Purpose: Hospital services are reduced during off-hour such as nighttime or weekend. Investigations of the off hour effect on initial management and outcomes in sepsis are very limited. Thus, we tested the hypothesis that patients who were diagnosed with severe sepsis during the nighttime or on non-business days had altered initial management and clinical outcomes.Materials and methods: Patients with severe sepsis from 59 ICUs between 2016 and 2017 were enrolled. The patients were categorized according to the diagnosis time or day and were then compared. The primary outcome was in-hospital mortality.Results: One thousand one hundred and forty-eight patients were analyzed: 769 daytime patients, vs. 379 nighttime patients, and 791 business day patients vs. 357 non-business day patients. There were no significant differences in in-hospital mortality between either daytime and nighttime (24.4% vs. 21.4%, P = .27; nighttime, adjusted odds ratio [OR] 1.17, 95% confidence interval [CI], 0.87-1.59, P = .30) or between business and nonbusiness days (22.9% vs. 24.6%, P = .55; non-business day, adjusted OR 0.85, 95% CI 0.60-1.22, P = .85). Time to antibiotics was significantly shorter in the nighttime (114 vs. 89 min, P = .0055).Conclusions: Nighttime and weekends were not associated with increased in-hospital mortality of severe sepsis. (C) 2019 Elsevier Inc. All rights reserved.