Is there a relationship between trauma center volume and mortality?

Area of Science:

• Trauma Surgery
• Health Services Research
• Patient Outcomes

Background:

• Trauma center verification guidelines often mandate high annual patient admission volumes.
• Previous research on the link between hospital volume and trauma outcomes has yielded inconsistent findings.
• There is a need to clarify the relationship between patient volume and outcomes in trauma care.

Purpose of the Study:

• To investigate the association between patient volume and outcomes (mortality, length of hospital stay) in California trauma centers.
• To determine if hospital volume is a reliable predictor of trauma care quality.
• To inform trauma center verification criteria.

Main Methods:

• Analysis of 98,245 adult trauma patient admissions from 38 Level I and II trauma centers in California (1998-1999).
• Data sourced from the State of California Patient Discharge Data.
• Covariates included age, sex, injury mechanism, Injury Severity Score, and trauma center level; hospital volume was calculated from annual admissions.

Main Results:

• Hospital patient volume was not a significant predictor of mortality or length of hospital stay.
• Severely injured patients experienced worse outcomes in the highest volume trauma centers.
• No significant difference in outcomes was observed between low-volume and high-volume centers.

Conclusions:

• Hospital patient volume is not a strong proxy for patient outcomes in trauma care.
• Low-volume trauma centers can achieve outcomes comparable to high-volume centers.
• Trauma center verification should potentially prioritize institutional outcomes over patient volume metrics.