Relationship between trauma center volume and outcomes.

Area of Science:

• Trauma Surgery
• Health Services Research
• Patient Outcomes

Background:

• Regionalization of trauma care aims to improve outcomes by concentrating patients in high-volume centers.
• The relationship between institutional trauma volume and patient outcomes has not been definitively established.

Purpose of the Study:

• To investigate the association between trauma center volume and patient outcomes.
• To determine if higher trauma center volume correlates with improved survival and reduced hospital length of stay.

Main Methods:

• Retrospective cohort study involving 31 academic level I or II trauma centers in the US.
• Analysis of consecutive patients with penetrating abdominal injury (PAI) or multisystem blunt trauma.
• Comparison of outcomes (inpatient mortality, length of stay) between high-volume (>650 admissions/year) and low-volume (<=650 admissions/year) centers.

Main Results:

• High-volume centers showed significantly lower odds of death for PAI patients in shock (OR 0.02) and multisystem blunt trauma patients with coma (OR 0.49).
• No significant mortality benefit was observed in less severely injured patients (without shock or coma).
• Shorter hospital length of stay (LOS) was noted in high-volume centers for PAI patients with severe injuries and for all multisystem blunt trauma patients.

Conclusions:

• Trauma center volume exceeding 650 cases annually is strongly associated with improved mortality and reduced LOS.
• These benefits are most pronounced in high-risk trauma patients requiring intensive care.
• Findings support the regionalization of trauma care to high-volume centers for specific patient populations.