Association between volume of severely injured patients and mortality in German trauma hospitals

Abstract

BackgroundThe issue of patient volume related to trauma outcomes is still under debate. This study aimed to investigate the relationship between number of severely injured patients treated and mortality in German trauma hospitals.MethodsThis was a retrospective analysis of the TraumaRegister DGU® (2009–2013). The inclusion criteria were patients in Germany with a severe trauma injury (defined as Injury Severity Score (ISS) of at least 16), and with data available for calculation of Revised Injury Severity Classification (RISC) II score. Patients transferred early were excluded. Outcome analysis (observed versus expected mortality obtained by RISC‐II score) was performed by logistic regression.ResultsA total of 39 289 patients were included. Mean(s.d.) age was 49·9(21·8) years, 27 824 (71·3 per cent) were male, mean(s.d.) ISS was 27·2(11·6) and 10 826 (29·2 per cent) had a Glasgow Coma Scale score below 8. Of 587 hospitals, 98 were level I, 235 level II and 254 level III trauma centres. There was no significant difference between observed and expected mortality in volume subgroups with 40–59, 60–79 or 80–99 patients treated per year. In the subgroups with 1–19 and 20–39 patients per year, the observed mortality was significantly greater than the predicted mortality (P < 0·050). High‐volume hospitals had an absolute difference between observed and predicted mortality, suggesting a survival benefit of about 1 per cent compared with low‐volume hospitals. Adjusted logistic regression analysis (including hospital level) identified patient volume as an independent positive predictor of survival (odds ratio 1·001 per patient per year; P = 0·038).ConclusionThe hospital volume of severely injured patients was identified as an independent predictor of survival. A clear cut‐off value for volume could not be established, but at least 40 patients per year per hospital appeared beneficial for survival.

Inequality of trauma care under a single-payer universal coverage system in Taiwan: a nationwide cohort study from the National Health Insurance Research Database

“…We surmise that having zero trauma centres could be responsible for the poor outcome in zone 3. Trauma centres with a high volume of severe trauma patients have demonstrated survival benefits for patients across different countries and systems 34–36. Similar results can be found in the NHI system in Taiwan.…”

The volume-outcome relationship in severely injured patients: A systematic review and meta-analysis

“…Eleven of the seventeen (65%) studies on hospital volume reported lower mortality rates in high volume centers compared to low volume centers (15,17,(23)(24)(25)(26)(28)(29)(30)(31)(32). Five studies (28%) did not find a positive nor a negative association between hospital volume and mortality (16,(19)(20)(21)33).…”

“…Fifteen (83%) were retrospective cohort studies (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29), one study (6%) was a secondary analysis of two randomized controlled trials (30) and two studies (11%) were prospective cohort studies (31, 32) ( Table 1). Fifteen studies (83%) were conducted in the United States (15-17, 19-27, 30, 32, 33), one study (6%) was conducted in Germany (28), one study was conducted in Japan (29), and one study was conducted in the United Kingdom (31).…”

“…Seven studies (39%) (19,20,23,25,28,29,31) analyzed hospital volume as a continuous parameter and used the annual volume of severely injured patients (Table 1). Three studies (17%) (15, 24, 33) used a cut-off of 240 severely injured trauma patients per year.…”

Mortalidad y estancia hospitalaria relacionada con trauma ocupacional atendido durante el fin de semana en el servicio de emergencias.

“…Fin de semana, n (%) Entre semana, n (%) Total (19,5) 9991 (19,1) 12499 (19,2) 2009 2956 (22,9) 13131 (25,1) 16087 (24,7) 2010 3553 (27,6) 14680 (28,1) 18233 (27,9 Los traumas ocurridos en miembros superiores, las lesiones causadas por cuerpos extraños y aquellas tipificadas como luxaciones-esguinces-torceduras fueron las codificadas con mayor frecuencia, sin embargo, entre las mencionadas no se encontró un riesgo adicional de presentación en los diferentes momentos de la semana.…”