Evaluation and Implication of Case Volume Variation in Level 1 and 2 Trauma Centers

Area of Science:

• Trauma Surgery
• Healthcare Systems Analysis
• Quality Improvement

Background:

• Trauma center distribution must align with regional needs to maintain the volume-outcomes relationship.
• Variability in case volume affects trauma center distribution, patient outcomes, and skill maintenance.

Purpose of the Study:

• To evaluate variations in patient case volume and procedural volume across U.S. Level 1 and Level 2 trauma centers.
• To assess the relationship between procedural volume and case volume in trauma care.

Main Methods:

• Trauma centers were categorized into quintiles based on average annual patient volume (2017-2021) meeting American College of Surgery Trauma Quality Improvement Program (ACS TQIP) criteria.
• Patient characteristics and procedures were analyzed across different case volumes and trauma center verification levels.
• The proportion of procedures performed relative to potential indications was examined to evaluate procedural volume in relation to case volume.

Main Results:

• Analysis included 1,902,005 patients from 228 Level 1 and 288 Level 2 trauma centers.
• A fourfold difference in ACS TQIP qualifying patient volume was observed between the highest and lowest quintiles of Level 1 and 2 trauma centers.
• Lowest quintile centers performed minimal essential procedures (e.g., 22 hemorrhage control, 10 pelvic fracture operations annually); low-volume centers performed fewer procedures proportionally (e.g., hemorrhage control for hypotensive/tachycardic patients: 25.9% vs. 31.8%, P < 0.001).

Conclusions:

• Significant variation exists in trauma center case volumes, with 20% of Level 1 centers averaging fewer than two hemorrhage control procedures monthly.
• Low-volume trauma centers perform proportionally fewer procedures, suggesting unexplained variations in clinical practice patterns.