• Scand J Trauma Resus · Mar 2020

    Observational Study

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

    • Charlie A Sewalt, Eveline J A Wiegers, Fiona E Lecky, Dennis den Hartog, Schuit Stephanie C E SCE Department of Emergency Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands. , Esmee Venema, and Hester F Lingsma.
    • Department of Public Health, Erasmus MC University Medical Centre, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands. c.sewalt@erasmusmc.nl.
    • Scand J Trauma Resus. 2020 Mar 6; 28 (1): 18.

    BackgroundMany 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).MethodsA 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.ResultsA 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).ConclusionsDespite 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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