Rewrite the Headlines: So, should you wait until Monday to take your child to hospital?

Over the first few weeks of February, we’re showcasing the top entries in both the school and undergraduate categories of our Rewrite the Headlines competition (full list of winners here). We conclude the undergraduate entries today with the overall undergraduate winner, Abbey Wrathall at the University of Edinburgh.

So, should you wait until Monday to take your child to hospital?

Glaring tabloid headlines about increased risk of death in hospital at the weekends is currently fuelling the public and political desire to create a ‘7-day NHS’. This so-called ‘weekend effect’ has been demonstrated in vulnerable patients if they were admitted on Saturdays or Sundays, and this has led to a new focus on the outcomes in babies and children. With different studies apparently contradicting each other, how are we supposed to interpret the information, and are you really better waiting until Monday to take your sick child to hospital?

The initial claim

On the 24^th of November, The Independent published an article “Babies born at weekends ‘more likely’ to be stillborn or die in the first week of life”. The author reported an observational study originally published in the BMJ, comparing the outcomes of pregnant women and their newborn babies between different days of the week. The researchers looked at all outcomes from admissions between April 2010 and March 2012, totalling to 1.3 million births.

The lowest mortality rate among newborns occurred if they were born on a Tuesday, and the highest mortality rate on a Thursday. Newborns delivered on Saturdays and Sundays did not have the best outcomes, but neither did they have the worst. There were more cases per day during the week compared to the weekends.

The authors of the study recognised that there were significant numbers of external factors that were not accounted for which could be responsible for the difference. For examples it was noted that elective Caesarean sections do not take place on weekends, they did not account for the risk factors that the mother and baby had before being admitted, or even that fewer births take place on weekends. High-risk cases will obviously have a higher mortality rate, and are also more likely to be admitted as an emergency. Some complications that arise during labour are unavoidable and occur every day of the week, therefore the proportion of uncomplicated deliveries will be lower on the weekends as there are fewer total cases.  Finally, the research took the day of delivery as the measurement to compare outcomes, but did not consider the date of admission or length of stay in hospital before the birth took place, both of which could affect the outcome for the newborn.

The contrasting study

On Friday 27^th November, shortly after the publication of the above study, The Independent printed a follow-up article refuting claims of a deleterious weekend effect. A contrasting study was presented with the headline “Children no more likely to die if admitted to hospital at the weekend, study says”. Newer research analysed the outcomes of paediatric admissions to Scottish hospitals between January 2000 and December 2013. Over half a million admissions of patients under the age of 16 were examined.

A total of 335 deaths occurred during this period, 251 of which occurred during the week and 84 at the weekend. In the simplest form, these numbers suggest that fewer deaths occur on weekends than weekdays. Saturday was found to have the lowest number of admissions, but there was a higher percentage of patients requiring intensive or high-dependency care at the weekend. The authors acknowledged that this was due to the same number of children with very serious conditions admitted every day of the week, but due to lower total numbers at weekends they made up a greater proportion of admissions. Patients who came to hospital on a weekend were also less likely to be readmitted at a later date, clearly opposing commonly held belief that care is worse at the weekend.

The study highlighted the issue that there has been relatively little research on the numbers and outcomes of children admitted to hospital on different days of the week. The lead author emphasised that studies in adults cannot be generalised to the population as a whole, or applied to specific patient groups such as the young, and that research into paediatrics was much-needed.

What the headlines claimed

The initial sensation article made a bold claim: that babies were more likely to die in hospital at the weekend. In reality, the research showed the highest death rate on a Thursday, not at the weekend. The tagline attached to the headline stated this, but many skim the headlines obtaining an inaccurate perception of the situation. Sensational and inaccurate headlines risk misinforming the public, and are not helpful in debates about how to best optimise patient care and deliver weekend services.

The subsequent article was clearly linked to the first, stating in the tagline that it “contrasts with earlier study”. The press must be given credit for publishing both sides of the story by printing an apparently contradicting article; however, when the study populations are examined, the Scottish study examined all paediatric admissions, whereas the English one only looked at babies in their first week of life. Newborns are a very vulnerable population, and clearly their outcomes will be poorer; these differences mean that the two studies are not directly comparable. This difference is not highlighted by the author; however the later article portrayed research much more accurately, correctly stating that those admitted on weekends were not more likely to die; in fact they had better outcomes.

For the public, headlines like these make it very hard to know what to believe. We need the press to say that evidence is lacking, and the debate is ongoing, rather than producing very contradicting headlines. Do we fund a ‘7-day NHS’, when the evidence is not clear whether outcomes are worse at the weekends, or is the money better invested elsewhere in limited resources or lack of services? In the meantime, while the debate continues, it is best not to wait until Monday if your child is sick and requires attention.

Abbey Wrathall, University of Edinburgh

References:

Connor S. Babies born at weekends ‘more likely’ to be stillborn or die in first week of life. The Independent. 2015 24/11/2015.

Gallagher P. Children no more likely to die if admitted to hospital at the weekend, study says. The Independent. 2015.

Patients not more likely to die at weekends, say researchers [press release]. Royal College of Paediatrics and Child Health: RCPCH2015.

Palmer WL, Bottle A, Aylin P. Association between day of delivery and obstetric outcomes: observational study. BMJ. 2015;351.

The Rewrite the Headlines competition was supported by funding from the British Academy, with additional funding from the University of Strathclyde.

Prizes were supported by the British Academy, the University of Strathclyde, the School of Chemistry at the University of St. Andrews, the School of Social Work and Social Policy at the University of Strathclyde, the University of Dundee School of Life Sciences, and the Particle Physics Experiment Research Group at the University of Edinburgh, the Social Research Association, the Scottish History Society, and Palgrave Macmillan.

Competition details can be accessed at https://researchtheheadlines.org/rewritetheheadlines, and the full list of winners is available here.