Does Trauma Center Volume Matter? An Analysis of Trauma Center Volume on Outcome Using the TQIP/NTDB Database

Overview

Journal J Clin Med

Specialty General Medicine

Date 2024 Nov 27

PMID 39597797

Authors

Alan Cook

Nicholas J Larson

Heidi M Altamirano

Brittany Ray

Brandi Pero

Musharaf Mohiuddin

Rebecca Swindall

Carly Wadle

David J Dries

Benoit Blondeau

Frederick Rogers

Affiliations

Soon will be listed here.

Abstract

Increasing trauma center admission volume is said to decrease mortality. Evidence supporting this position is dependent upon patient groups and the time period studied, and gaps remain. We evaluated the effect of annual volume of critically injured patients on hospital mortality, comparing two time periods. The effect of critically injured patient volume on risk-adjusted mortality was hypothesized to decrease over time. This was a retrospective cohort study comparing data from an early group (2007-2011) and late group (2017-2021) of the National Trauma Data Bank. Critically injured adults (ISS > 15) admitted to the intensive care unit (ICU) or operating room from the emergency department at Level I and II trauma centers were included. The outcome of interest was risk-adjusted mortality across quintiles of patient admission volume, modeled using mixed-effects generalized linear models. In total, 802,824 patients were included, 321,209 and 481,615 in the early and late groups, respectively. In the early group, increased patient volume was associated with a decreased risk-adjusted odds of mortality. This association was not seen in the late group. The overall odds of mortality in the late group demonstrated decreased mortality over time (OR 0.84, < 0.001). : The annual volume of critically injured patients was associated with decreased odds of hospital mortality during 2007-2011, though this effect was no longer present in the 2017-2021 sample. The continued dissemination of the best practices is warranted to decrease mortality, regardless of the admission volume of critically injured patients.

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