Relationship Between Trauma Center Volume and Outcomes

Nathens, Avery B.; Jurkovich, Gregory J.; Maier, Ronald V.; Grossman, David C.; MacKenzie, Ellen J.; Moore, Maria; Rivara, Frederick P.

doi:10.1001/jama.285.9.1164

Cited by 517 publications

(330 citation statements)

References 24 publications

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“…Pediatric trauma patients brought to an adult trauma center had acceptable outcomes compared to non-trauma centers, but children who suffered significant blunt trauma were found to have better outcomes if they were treated at a pediatric trauma center. Overall, children treated at a pediatric trauma center may have improved survival and functional outcomes [36][37][38][39][40][41]. These findings suggest that the disparity in pediatric trauma care during routine events may extend to outcomes after mass casualty events.…”

Section: Disaster Response and Follow-upmentioning

confidence: 88%

Planning for the Pediatric Patient During a Disaster

et al. 2016

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Purpose of Review Disaster and mass casualty events are unpredictable and quickly overwhelm response systems. Children are affected by disasters; however, pediatricspecific disaster preparedness is lacking. Preparedness is required at the individual, physician, and hospitals/community levels and constitutes material allocation, education, and communication. Specifically, pediatricians, pediatric subspecialists, and pediatric surgical subspecialists have important roles during a disaster, mass casualty, or pandemic response; thus, integration of both community and subspecialty physicians is important. Disaster response is not limited to planning and response; major efforts in recovery, reunification, community health safety, and follow-up are required. Recent Findings Events have highlighted the need for improved preparation and execution of mass casualty response. There is a need for training in the event of a mass casualty disaster, and pediatric professionals have indicated that they do not feel adequately prepared to care for children during such events. Incorporation of pediatric-specific simulation scenarios can help address this deficiency.Summary Thus, efforts to incorporate pediatric-specific education, disaster simulation, and preparation including a multidisciplinary approach integrating families, physicians, and hospital and community organizations are required.

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Section: Disaster Response and Follow-upmentioning

confidence: 88%

Planning for the Pediatric Patient During a Disaster

et al. 2016

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“…The low volumes of OHCA patients seen by many New Jersey hospitals highlights the need to better understand whether there is a volume-outcome relationship for TH similar to that which has been demonstrated for other medical interventions, particularly those involving cardiac procedures (Canto et al, 2000;Nathens et al, 2001;Birkmeyer et al, 2003;Carr et al, 2009a). One recent study in particular finds that survival from OHCA is greatly reduced in hospitals that treat fewer than 40 cases per year .…”

Section: Discussionmentioning

confidence: 98%

Post-Cardiac Arrest Therapeutic Hypothermia in New Jersey Hospitals: Analysis of Adoption and Implementation

DeLia

Wang

Kutzin

et al. 2012

Therapeutic Hypothermia and Temperature Management

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“…Centralising patients to centres with high volumes of activity is associated with better outcome, both for TBI [4][5][6][7] and after neurosurgery [8]. For a Hub & Spoke ICU system to work well, patients who no longer require the specific skills of the specialist ICU need to be repatriated as soon as clinically feasible.…”

Section: Discussionmentioning

confidence: 99%

“…The Hub ICU treats major trauma and neurosurgical patients, who are centralised to the Hub ICU. Centralising selected patients allows increased volume of activity for specific conditions, and improves patient outcomes [3][4][5][6][7][8]. Spoke ICUs admit patients with less severe disease, patients not expected to benefit from care in specialist ICUs, and patients discharged from the Hub ICU.…”

Section: Introductionmentioning

confidence: 99%

Satisfaction of patients’ next of kin in a ‘Hub & Spoke’ ICU network

et al. 2014

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SummaryThis study aimed to gauge the opinions of patients' next of kin regarding transfer of patients from the specialist ‘Hub’ intensive care unit, to ‘Spoke’ intensive care units near home. We included 213 consecutive patients with severe trauma or severe acute neurological conditions admitted to the Hub intensive care unit over a 21‐month period, who were repatriated to Spoke intensive care units for ongoing intensive care. One year after admission to the Hub intensive care unit, two thirds of patients' next of kin said they would have preferred patients to have been treated only in the Hub intensive care unit, and not repatriated. They perceived Hub intensive care unit care to be important, and would have preferred that their relatives be hospitalised there until intensive treatment was completed. The next of kin's preference was associated with severe acute neurological conditions (p ≤ 0.0001). Although centralised Hub & Spoke intensive care unit networks are appropriate to ensure specialised care, repatriation to local hospitals may not be appropriate for patients with severe neurological conditions.

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Relationship Between Trauma Center Volume and Outcomes

Abstract: Our results indicate that a strong association exists between trauma center volume and outcomes, with significant improvements in mortality and LOS when volume exceeds 650 cases per year. These benefits are only evident in patients at high risk for adverse outcomes.

Cited by 517 publications

References 24 publications

Planning for the Pediatric Patient During a Disaster

Planning for the Pediatric Patient During a Disaster

Post-Cardiac Arrest Therapeutic Hypothermia in New Jersey Hospitals: Analysis of Adoption and Implementation

Satisfaction of patients’ next of kin in a ‘Hub & Spoke’ ICU network

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