The relationship between trauma center volume and in-hospital outcomes

Bell, Teresa M.; Boustany, Karim; Jenkins, Peter C.; Zarzaur, Ben L.

doi:10.1016/j.jss.2015.02.009

Cited by 43 publications

(38 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similar VORs have been demonstrated for neurosurgery 4,11,37,40,41 and adult trauma care. 6,32,38 In the present study, we focused exclusively on how pediatric tICH outcomes are associated with hospital volume, rather than provider volume, because the NIS and NTDB have limited data on provider volume. Moreover, earlier research has indicated that a higher hospital caseload confers benefits beyond those impacting individual physicians.…”

Section: Discussionmentioning

confidence: 99%

“…7 Furthermore, Bell et al determined that a higher trauma volume is not associated with failure to rescue, which they used as a proxy for excessively strained resources. 6 Finally, consolidating pediatric neurotrauma treatment away from low-volume institutions may exacerbate the financial strain and closure of these centers, which commonly operate in medically underserved areas. 30,39 Over 300 trauma centers closed in the period 1990-2005.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Volume-outcome relationship in pediatric neurotrauma care: analysis of two national databases

Tang

Yoon

Kimata

et al. 2019

Neurosurgical Focus

View full text Add to dashboard Cite

OBJECTIVEPrevious research has demonstrated the association between increased hospital volume and improved outcomes for a wide range of neurosurgical conditions, including adult neurotrauma. The authors aimed to determine if such a relationship was also present in the care of pediatric neurotrauma patients.METHODSThe authors identified 106,146 pediatric admissions for traumatic intracranial hemorrhage (tICH) in the National Inpatient Sample (NIS) for the period 2002–2014 and 34,017 admissions in the National Trauma Data Bank (NTDB) for 2012–2015. Hospitals were stratified as high volume (top 20%) or low volume (bottom 80%) according to their pediatric tICH volume. Then the association between high-volume status and favorable discharge disposition, inpatient mortality, complications, and length of stay (LOS) was assessed. Multivariate regression modeling was used to control for patient demographics, severity metrics, hospital characteristics, and performance of neurosurgical procedures.RESULTSIn each database, high-volume hospitals treated over 60% of pediatric tICH admissions. In the NIS, patients at high-volume hospitals presented with worse severity metrics and more frequently underwent neurosurgical intervention over medical management (all p < 0.001). After multivariate adjustment, admission to a high-volume hospital was associated with increased odds of a favorable discharge (home or short-term facility) in both databases (both p < 0.001). However, there were no significant differences in inpatient mortality (p = 0.208). Moreover, high-volume hospital patients had lower total complications in the NIS and lower respiratory complications in both databases (all p < 0.001). Although patients at high-volume hospitals in the NTDB had longer hospital stays (β-coefficient = 1.17, p < 0.001), they had shorter stays in the intensive care unit (β-coefficient = 0.96, p = 0.024). To determine if these findings were attributable to the trauma center level rather than case volume, an analysis was conducted with only level I pediatric trauma centers (PTCs) in the NTDB. Similarly, treatment at a high-volume level I PTC was associated with increased odds of a favorable discharge (OR 1.28, p = 0.009), lower odds of pneumonia (OR 0.60, p = 0.007), and a shorter total LOS (β-coefficient = 0.92, p = 0.024).CONCLUSIONSPediatric tICH patients admitted to high-volume hospitals exhibited better outcomes, particularly in terms of discharge disposition and complications, in two independent national databases. This trend persisted when examining level I PTCs exclusively, suggesting that volume alone may have an impact on pediatric neurotrauma outcomes. These findings highlight the potential merits of centralizing neurosurgery and pursuing regionalization policies, such as interfacility transport networks and destination protocols, to optimize the care of children affected by traumatic brain injury.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Volume-outcome relationship in pediatric neurotrauma care: analysis of two national databases

Tang

Yoon

Kimata

et al. 2019

Neurosurgical Focus

View full text Add to dashboard Cite

show abstract

“…Several studies found a correlation between high volume and improved outcome, especially in high-risk surgical and trauma patients (29)(30)(31) However, other studies found no association between institution or surgeon volume and survival. (32-34) Bell et al (35) investigated the relationship between trauma center volume and in-hospital outcome and showed that higher hospital volumes were associated with decreased likelihood of mortality but not for complication or FTR.…”

Section: Discussionmentioning

confidence: 99%

Mortality of severely injured patients after ICU discharge: An underestimated problem?

Hamsen

Drotleff

Lefering

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Most trauma patients admitted to the hospital alive and die later on, decease during the initial care in the emergency department or the intensive care unit (ICU). However, a number of patients pass away after having been discharged from the ICU during the initial hospital stay. On first sight these cases could be seen as "failure to rescue" of potentially salvageable patients. A low rate of such patients might be a potential indicator of quality for trauma care on ICUs and surgical wards.Methods Retrospective analysis of the TraumaRegister DGU® with data from 2015-2017. Patients that died during the initial ICU stay were compared to those who were discharged from the initial ICU stay for at least 24 hours but died later on.Results A total of 82,313 trauma patients were included in the TraumaRegister DGU®. In total, 6,576 patients (8.0%) died during their hospital stay. Out of those, 5,481 were admitted to the ICU alive and 972 patients (17.7%) were discharged from ICU and died later on. Those were older (mean age: 77 vs. 68 years), less severely injured (mean ISS: 23.1 vs. 30.0 points) and had a longer mean ICU length of stay (10 vs. 6 days). A limitation of life-sustaining therapy due to a documented living will was present in 46.1% of all patients who died during their initial ICU stay and in 59.9% of patients who died after discharge from their initial ICU stay.Conclusions 17.7% of all non-surviving severely injured trauma patients died within the hospital after discharge from their initial ICU treatment. Their death can partially be explained by a limitation of therapy due to a living will. In conclusion, the rate of such late deaths may represent patients that died of potentially avoidable or treatable complications.

show abstract

“…Several studies found a correlation between high volume and improved outcome, especially in high-risk surgical and trauma patients (30-32) However, other studies found no association between institution or surgeon volume and survival. (33-35) Bell et al (36) investigated the relationship between trauma center volume and in-hospital outcome and showed that higher hospital volumes were associated with decreased likelihood of mortality but not for complication or FTR.…”

Section: Discussionmentioning

confidence: 99%

Mortality of severely injured patients after ICU discharge: An underestimated problem?

Hamsen

Drotleff

Lefering

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundMost trauma patients admitted to the hospital alive and die later on, decease during the initial care in the emergency department or the intensive care unit (ICU). However, a number of patients pass away after having been discharged from the ICU during the initial hospital stay. On first sight these cases could be seen as “failure to rescue” of potentially salvageable patients. A low rate of such patients might be a potential indicator of quality for trauma care on ICUs and surgical wards.MethodsRetrospective analysis of the TraumaRegister DGU® with data from 2015-2017. Patients that died during the initial ICU stay were compared to those who were discharged from the initial ICU stay for at least 24 hours but died later on.ResultsA total of 82,313 trauma patients were included in the TraumaRegister DGU®. In total, 6,576 patients (8.0%) died during their hospital stay. Out of those, 5,481 were admitted to the ICU alive and 972 patients (17.7%) were discharged from ICU and died later on. Those were older (mean age: 77 vs. 68 years), less severely injured (mean ISS: 23.1 vs. 30.0 points) and had a longer mean ICU length of stay (10 vs. 6 days). A limitation of life-sustaining therapy due to a documented living will was present in 46.1% of all patients who died during their initial ICU stay and in 59.9% of patients who died after discharge from their initial ICU stay.Conclusions17.7% of all non-surviving severely injured trauma patients died within the hospital after discharge from their initial ICU treatment. Their death can partially be explained by a limitation of therapy due to a living will. In conclusion, the rate of such late deaths may represent patients that died of potentially avoidable or treatable complications.

show abstract

The relationship between trauma center volume and in-hospital outcomes

Cited by 43 publications

References 39 publications

Volume-outcome relationship in pediatric neurotrauma care: analysis of two national databases

Volume-outcome relationship in pediatric neurotrauma care: analysis of two national databases

Mortality of severely injured patients after ICU discharge: An underestimated problem?

Mortality of severely injured patients after ICU discharge: An underestimated problem?

Contact Info

Product

Resources

About