High-volume trauma centers have better outcomes treating traumatic brain injury

Tepas, Joseph J.; Pracht, Etienne E.; Orban, Barbara; Flint, Lewis M.

doi:10.1097/ta.0b013e3182788b5a

Cited by 52 publications

(30 citation statements)

References 5 publications

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“…The lower SMR may be interpreted as an indicator of the quality of performance, although one should keep in mind that these systems potentially might overestimate the mortality rate and need to be recalibrated for updated data and for trauma patients before such conclusion can be made. Additionally, several studies reported a positive correlation with a strong association between trauma volume centre and outcomes of trauma patients with significant improvements in mortality when volume exceeds 650 cases per year [30][31][32]. The high volume, more than a 1000 trauma cases every year, may have been potentially a contributing factor to the improved primary outcome in our abdomino-pelvic trauma patients.…”

Section: Discussionmentioning

confidence: 90%

Profile, outcome and predictors of mortality of abdomino-pelvic trauma patients in a tertiary intensive care unit in Saudi Arabia

Haddad

Yousef

Al-Azzam

et al. 2015

Injury

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Section: Discussionmentioning

confidence: 90%

Profile, outcome and predictors of mortality of abdomino-pelvic trauma patients in a tertiary intensive care unit in Saudi Arabia

Haddad

Yousef

Al-Azzam

et al. 2015

Injury

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“…Finally, the low in-hospital and 5-year mortality rates observed in patients treated by surgeons who had performed a high volume of TBIs in the previous year and the positive association observed between TBI outcomes and volume of surgeries performed by the surgeon and by the hospital in the previous year are consistent with those in other longitudinal studies. 21,24 In the current study, the trend analysis of TBI reveals increasing hospital resource utilization, decreasing in-hospital mortality, and an increasing temporal trend in the prevalence of TBI, especially in elderly patients. All 3 trends were simultaneous and consistent over time.…”

Section: Discussionmentioning

confidence: 99%

Trends and outcome predictors after traumatic brain injury surgery: a nationwide population-based study in Taiwan

Shi¹,

Hwang

Lee³

et al. 2014

JNS

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Object.The authors sought to analyze trends in hospital resource utilization and mortality rates in a population of patients who had received traumatic brain injury (TBI) surgery.Methods. This nationwide population-based cohort study retrospectively analyzed 18,286 patients who had received surgical treatment for TBI between 1998 and 2010. The multiple linear regression model and Cox proportional hazards model were used for multivariate assessment of outcome predictors.Results. The prevalence rate of surgical treatment for patients with TBI gradually but significantly (p < 0.001) increased by 47.6% from 5.0 per 100,000 persons in 1998 to 7.4 per 100,000 persons in 2010. Age, sex, DeyoCharlson comorbidity index score, hospital volume, and surgeon volume were significantly associated with TBI surgery outcomes (p < 0.05). Over the 12-year period analyzed, the estimated mean hospital treatment cost increased 19.06%, whereas the in-hospital mortality rate decreased 10.9%. The estimated mean time of overall survival after TBI surgery (± SD) was 83.0 ± 4.2 months, and the overall in-hospital and 1-, 3-, and 5-year survival rates were 74.5%, 67.3%, 61.1%, and 57.8%, respectively.Conclusions. These data reveal an increased prevalence of TBI, especially in older patients, and an increased hospital treatment cost but a decreased in-hospital mortality rate. Health care providers and patients should recognize that attributes of the patient and of the hospital may affect hospital resource utilization and the mortality rate. These results are relevant not only to other countries with similar population sizes but also to countries with larger populations. (http://thejns.org/doi/abs/10.3171/2014.8.JNS131526) KeY worDS • traumatic brain injury • trends • predictors • hospital resource utilization • mortality rateAbbreviations used in this paper: BNHI = Bureau of National Health Insurance; DCCI = Deyo-Charlson comorbidity index; ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification; IQR = interquartile range; LOS = length of stay; TBI = traumatic brain injury.* Drs. K. T. Lee and Lin contributed equally to this study.

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“…Other authors have shown that in an analysis within level I centers only, a driving force that determines survival is volume and as trauma center volume increases the odds of mortality decrease. 2, 19 A possible explanation for our data not showing a 24-hour survival advantage in level I designated centers may be related to findings in the original study. In the original study reported by Bulger 10 there was a higher mortality in the hypertonic saline cohorts in the subgroup of patients who did not receive blood transfusions in the first 24 hours, compared to the control group receiving normal saline.…”

Section: Discussionmentioning

confidence: 69%

“…Many of these studies rely on administrative datasets, 5, 18, 19 statewide registries 8, 20–22 or the National Trauma Data Bank (NTDB) 2, 7, 9 where accuracy and validity of data has been questioned. 23–25 An advantage of this study is that it is based on prospectively collected data with quality control and review and does not rely on administrative datasets or registry downloads.…”

Section: Discussionmentioning

confidence: 99%

Increased Trauma Center Volume Is Associated With Improved Survival After Severe Injury

et al. 2014

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Structured Abstract OBJECTIVE The Resuscitation Outcomes Consortium (ROC) is a network of 11 centers and 60 hospitals conducting emergency care research. For many procedures, high volume centers demonstrate superior outcomes versus low volume centers. This remains controversial for trauma center outcomes. This study investigated the relationship of trauma center volume on outcome. METHODS This study was a secondary analysis of prospectively collected data from the ROC multicenter out-of-hospital Hypertonic Saline Trial in patients with GCS ≤ 8 (traumatic brain injury [TBI]) or SBP ≤ 90 and pulse ≥ 110 (shock). Regression analyses evaluated associations between trauma volume and the following outcomes: 24 hour mortality, 28 day mortality, ventilator free days (VFD), Multiple Organ Dysfunction Scale (MODS) incidence, worst MODS score, and poor 6 month Glasgow outcome scale extended. RESULTS 2070 patients were analyzed: 1251 in the TBI cohort and 819 in the shock cohort. Overall, 24-hour and 28-day mortality were 16% and 25%, respectively. For every increase of 500 trauma center admissions, there was a 7% decreased odds of both 24-hour and 28-day mortalities for all patients. As trauma center volume increased, non-organ dysfunction complications increased, VFD increased and worst MODS score decreased. The associations with higher trauma center volume were similar for the TBI cohort, including better neurologic outcomes at 6 months, but not for the shock cohort. CONCLUSIONS Increased trauma center volume was associated with increased survival, more ventilator free days and less severe organ failure. Trauma system planning and implementation should avoid unnecessary duplication of services.

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High-volume trauma centers have better outcomes treating traumatic brain injury

Abstract: Epidemiologic study, level III.

Cited by 52 publications

References 5 publications

Profile, outcome and predictors of mortality of abdomino-pelvic trauma patients in a tertiary intensive care unit in Saudi Arabia

Profile, outcome and predictors of mortality of abdomino-pelvic trauma patients in a tertiary intensive care unit in Saudi Arabia

Trends and outcome predictors after traumatic brain injury surgery: a nationwide population-based study in Taiwan

Increased Trauma Center Volume Is Associated With Improved Survival After Severe Injury

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