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

Sewalt, Charlie; Wiegers, Eveline; Venema, Esmée; Lecky, Fiona; Schuit, Stephanie C. E.; Hartog, Dennis den; Lingsma, Hester F.

doi:10.1097/ta.0000000000002043

Cited by 56 publications

(65 citation statements)

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“…This study aimed to evaluate whether there was an association between hospital volume and outcomes among severely injured patients in Major Trauma Centres. Despite the large variation in volume of the included MTCs, no relationship between hospital volume and outcome of severely injured patients was found, contrary to current beliefs [5]. Small between-centre differences for in-hospital mortality were found which suggests comparable outcomes between MTCs.…”

Section: Discussioncontrasting

confidence: 81%

“…The current study showed no evidence for the volume-outcome relationship in severely injured patients treated in MTCs. This is in contrast with a recently published systematic review and meta-analysis which found a beneficial effect for high volume centres [5]. However, most of these studies included both MTCs and non MTCs, so a potential volume effect could be biased by other factors.…”

Section: Discussionmentioning

confidence: 65%

“…It was not possible to assess the relationship between surgeon volume and outcomes. Other studies that investigated this relationship showed inconsistent results [5,[27][28][29]. The caseload and experience per surgeon might influence between-centre differences.…”

Section: Discussionmentioning

confidence: 99%

“…Implicit to the centralization of trauma care is the idea that increased volumes of severely injured patients lead to more experienced health care providers, which could result in improved patient outcomes. A recently published systematic review showed that higher hospital volume is associated with lower mortality in severely injured patients [5]. However, hospitals treating severely injured patients do not only differ in hospital volume.…”

Section: Introductionmentioning

confidence: 99%

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The volume-outcome relationship among severely injured patients admitted to English major trauma centres: a registry study

Sewalt

Wiegers

Lecky

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: Many countries have centralized and dedicated trauma centres with high volumes of trauma patients. However, the volume-outcome relationship in severely injured patients (Injury Severity Score (ISS) > 15) remains unclear. The aim of this study was to determine the association between hospital volume and outcomes in Major Trauma Centres (MTCs). Methods: A retrospective observational cohort study was conducted using the Trauma Audit and Research Network (TARN) consisting of all English Major Trauma Centres (MTCs). Severely injured patients (ISS > 15) admitted to a MTC between 2013 and 2016 were included. The effect of hospital volume on outcome was analysed with random effects logistic regression models with a random intercept for centre and was tested for nonlinearity. Primary outcome was in-hospital mortality.Results: A total of 47,157 severely injured patients from 28 MTCs were included in this study. Hospital volume varied from 69 to 781 severely injured patients per year. There were small between-centre differences in mortality after adjusting for important demographic and injury severity characteristics (adjusted 95% odds ratio range: 0.99-1.01). Hospital volume was found to be linear and not associated with in-hospital mortality (adjusted odds ratio (aOR) 1.02 per 10 patients, 95% confidence interval (CI) 0.68-1.54, p = 0.92). Conclusions:Despite the large variation in volume of the included MTCs, no relationship between hospital volume and outcome of severely injured patients was found. These results suggest that centres with similar structure and processes of care can achieve comparable outcomes in severely injured patients despite the number of severely injured patients they treat.

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Section: Discussioncontrasting

confidence: 81%

Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The volume-outcome relationship among severely injured patients admitted to English major trauma centres: a registry study

Sewalt

Wiegers

Lecky

et al. 2020

Scand J Trauma Resusc Emerg Med

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“…Adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) were obtained after adjusting for age (16-39 vs. 40-64 vs. 65≤); gender; mechanism of injury (blunt or others); transfer from outside hospitals; ISS (≤8 vs. 9-15 vs. 90mmHg≤ on arrival); Glasgow Coma Scale score (≤8 vs. 9-15); presence or absence of emergency surgical or hemostatic intervention (craniotomy, thoracotomy, laparotomy, or angioembolization); and type of institution (high vs. low volume centers). Because outcomes would be better at the high-volume centers, an additional analysis was conducted by dividing the patients into two groups; high volume centers (≥1,200 cases with ISS≥9 registered for 12 years) and low volume centers (<1,200 cases with ISS≥9 registered for 12 years) [18]. A subgroup analysis was also conducted, stratifying patients with or without shock and the type of national meeting.…”

Section: Methodsmentioning

confidence: 99%

Mortality in trauma patients admitted during, before, and after national academic emergency medicine and trauma surgery meeting dates in Japan

Yumoto

Naito

Ihoriya

et al. 2018

Preprint

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13 14 15 16 2 17 Abstract18 Annually, many physicians attend national academic meetings. While participating in these meetings 19 can have a positive impact on daily medical practice, attendance may result in reduced medical 20 staffing during the meeting dates. We sought to examine whether there were differences in mortality 21 after trauma among patients admitted to the hospital during, before, and after meeting dates. Using 22 the Japan Trauma Data Bank, we analyzed in-hospital mortality in patients with traumatic injury 23 admitted to the hospital from 2004 to 2015 during the dates of two national academic meetings -the 24 Japanese Association for Acute Medicine (JAAM) and the Japanese Association for the Surgery of 25 Trauma (JAST). We compared the data with that of patients admitted with trauma during identical 26 weekdays in the weeks before and after the meetings, respectively. We used multiple logistic 27 regression analysis to compare outcomes among the three groups. A total of 7,491 patients were 28 included in our analyses, with 2,481, 2,492, and 2,518 patients in the during, before, and after 29 meeting dates groups, respectively; their mortality rates were 7.3%, 8.0%, and 8.5%, respectively.30 After adjusting for covariates, no significant differences in in-hospital mortality were found among 31 the three groups (adjusted odds ratio [95% CI] of the before meeting dates and after meeting dates 32 groups; 1.18 [0.89-1.56] and 1.23 [0.93-1.63], respectively, with the during meeting dates group as 3 33 the reference category). No significant differences in in-hospital mortality were found among trauma 34 patients admitted during, before, and after the JAAM and JAST meeting dates. 36 Introduction37 Appropriate medical staffing is essential to provide optimal trauma care [1]. Weekend or off-hours 38 admission has been shown to be associated with worse outcomes in patients with acute myocardial 39 infarction (AMI), stroke, pulmonary embolism, or those who required emergency general surgery 40 and were admitted to the intensive care unit [2][3][4][5][6]. This so-called "weekend effect" could possibly be 41 explained by reduced medical staffing and resources [7, 8]. 4243 This "national meeting effect" has been examined in recent years [9][10][11][12]. Each year, many 44 physicians attend national academic meetings and conferences to present their work, gain new 45 knowledge, and network. Although hospitals aim to consistently deliver high quality patient care 46 through efficient allocation of staff physicians, medical staffing during national meetings dates may 47 be lower than that during non-meeting dates. The "national meeting effect" in Japan has been 48 investigated; no significant differences were observed in outcomes among patients hospitalized with 4 49 AMI or cardiac arrest between meeting dates and non-meeting dates [9, 10]. Interestingly, lower 30-50 day mortality was found among high-risk patients with AMI, cardiac arrest, and heart failure in 51 teaching hospitals in the United States during na...

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Association of Annual Intensive Care Unit Sepsis Caseload With Hospital Mortality From Sepsis in the United Kingdom, 2010-2016

2021

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

Abstract: Systematic review and meta-analysis, level III. Systematic review registration number: PROSPERO registration ID CRD42017056729.

Cited by 56 publications

References 46 publications

The volume-outcome relationship among severely injured patients admitted to English major trauma centres: a registry study

The volume-outcome relationship among severely injured patients admitted to English major trauma centres: a registry study

Mortality in trauma patients admitted during, before, and after national academic emergency medicine and trauma surgery meeting dates in Japan

Association of Annual Intensive Care Unit Sepsis Caseload With Hospital Mortality From Sepsis in the United Kingdom, 2010-2016

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