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

Area of Science:

• Trauma Surgery
• Critical Care Medicine
• Health Services Research

Background:

• Trauma center admission volume is often linked to reduced mortality, but evidence varies by patient group and time.
• Gaps exist in understanding the relationship between patient volume and outcomes in critically injured patients.
• This study investigates the impact of annual patient volume on hospital mortality across two distinct time periods.

Purpose of the Study:

• To evaluate the effect of critically injured patient volume on hospital mortality.
• To compare this effect between an early (2007-2011) and a late (2017-2021) time period.
• To test the hypothesis that the volume-mortality association diminishes over time.

Main Methods:

• Retrospective cohort study using the National Trauma Data Bank (2007-2011 and 2017-2021).
• Included critically injured adults (Injury Severity Score > 15) admitted to ICU or OR from the ED at Level I/II trauma centers.
• Risk-adjusted mortality was modeled across patient admission volume quintiles using mixed-effects generalized linear models.

Main Results:

• 802,824 patients were analyzed (321,209 early, 481,615 late).
• In the early period, increased patient volume correlated with decreased risk-adjusted mortality odds.
• This volume-mortality association was absent in the late period; however, overall mortality decreased over time (OR 0.84, p < 0.001).

Conclusions:

• The association between higher annual patient volume and reduced mortality was observed in 2007-2011 but not in 2017-2021.
• Overall mortality decreased over time, irrespective of patient volume.
• Continuous dissemination of best practices is crucial for reducing mortality in critically injured patients, regardless of trauma center volume.