• Jason Shahin, David A Harrison, and Kathryn M Rowan.
• Department of Critical Care, Respiratory Division, McGill University, 1650 Cedar Avenue, Montreal, Quebec, Canada H3G 1A4. Jason.shahin@mcgill.ca
• BMJ. 2012 Jan 1;344:e3394.

ObjectiveTo evaluate whether a relation exists between volume and outcome for admissions with severe sepsis to adult general critical care units in the United Kingdom.DesignRetrospective cohort study using data from a pooled case mix and outcome database.SettingAdult general critical care units participating in the case mix programme.ParticipantsConsecutive admissions to participating units for the years 2008-09 meeting objective, standardised criteria for severe sepsis.Main Outcome MeasuresMortality at ultimate discharge from acute hospital.ResultsThe primary exposure was volume of admissions with severe sepsis per unit per year. A multivariable logistic regression analysis, using generalised estimating equations, was used to assess the association between volume, modelled using fractional polynomials, and ultimate acute hospital mortality while adjusting for potential confounders. No relation was seen between volume and outcome for admissions with severe sepsis to adult, general critical care units in the UK. Subgroup analyses tested for interactions between the effect of volume and acute severity of illness or receipt of mechanical ventilation. No significant interactions were found.ConclusionsThis study showed no relation between volume and outcome in admissions with severe sepsis treated in adult general critical care units in the UK.

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