The relationship between hospital volume and in-hospital mortality of severely injured patients in Dutch level-1 trauma centers

Sewalt, C.A.; Venema, E.; Zwet, E. van; Ditshuizen, J.C. van; Schuit, S.C.E.; Polinder, S.; ... ; LTR Res Grp (2021)

Article / Letter to editor

Centralization of trauma centers leads to a higher hospital volume of severely injured patients (Injury Severity Score (ISS) > 15), but the effect of volume on outcome remains unclear. The aim of this study was to determine the association between hospital volume of severely injured patients and in-hospital mortality in Dutch Level-1 trauma centers. A retrospective observational cohort study was performed using the Dutch trauma registry. All severely injured adults (ISS > 15) admitted to a Level-1 trauma center between 2015 and 2018 were included. The effect of hospital volume on in-hospital mortality was analyzed with random effects logistic regression models with a random intercept for Level-1 trauma center, adjusted for important demographic and injury characteristics. A total of 11,917 severely injured patients from 13 Dutch Level-1 trauma centers was included in this study. Hospital volume varied from 120 to 410 severely injured patients per year. Observed mortality rates varied between 12% and 24% per center. After case-mix correction, no statistically significant differences between low- and high-volume centers were demonstrated (adjusted odds ratio 0.97 per 50 extra patients per year, 95% Confidence Interval 0.90-1.04, p = 0.44). The variation in hospital volume of the included Level-1 trauma centers was not associated with the outcome of severely injured patients. Our results suggest that well-organized trauma centers with a similar organization of care could potentially achieve comparable outcomes.

• volume-outcome relationship
• major trauma
• centralization

• All authors: Sewalt, C.A.; Venema, E.; Zwet, E. van; Ditshuizen, J.C. van; Schuit, S.C.E.; Polinder, S.; Lingsma, H.F.; Hartog, D. den; LTR Res Grp
• Date: 2021-04-01
• Journal: Journal of Clinical Medicine
• Volume: 10
• Issue: 8
• DOI: doi:10.3390/jcm10081700
• Link: https://www.mdpi.com/2077-0383/10/8/1700/pdf