Increased Trauma Center Volume is Associated with Improved Survival After Severe Injury: Results from a Resuscitation Outcomes Consortium (ROC) Study
Joseph P. Minei1, Timothy C Fabian2, Danielle M. Guffey*3, Craig Newgard*4, Eileen M. Bulger3, Karen J. Brasel5, Jason Sperry*6, Russell D MacDonald*7
1University of Texas Southwestern Medical Center, Dallas, TX;2University of Tennessee Health Science Center, Memphis, TN;3University of Washington, Seattle, WA;4Oregan Health and Science University, Portland, OR;5Medical College of Wisconsin, Milwaukee, WI;6University of Pittsburgh, Pittsburgh, PA;7University of Toronto, Toronto, ON, Canada
OBJECTIVE: ROC is an NHLBI sponsored network of 11 centers and 60 hospitals for conducting emergency care research. For several procedures high volume centers demonstrate superior outcomes versus low volume centers. This remains controversial for trauma center outcomes.
METHODS: This study was a secondary analysis of prospectively collected data from the ROC multicenter prehospital Hypertonic Saline Trial in patients with GCS ≤ 8 (traumatic brain injury [TBI]) or SBP ≤ 90 and pulse ≥ 110 (shock). Regression analyses evaluated associations between trauma volume and the following outcomes: 24 hour mortality, 28 day mortality, ventilator free days (VFD), worst MODS score, and poor 6 month Glasgow outcome scale extended (6M-GOSE ≤ 4).
RESULTS: 2070 patients were enrolled; 1251 in the TBI cohort and 819 in the shock cohort. Overall 24 hour and 28-day mortality were 16% and 25%, respectively. For every 1000 patient admission increase, there were 13% and 14% relative decreases in 24 hour and 28-day mortalities, respectively for all patients. VFD increased and worst MODS decreased as volume increased (Table). Findings were similar for TBI, including better neurologic outcomes (6M-GOSE ≤ 4 in TBI cohort OR 0.85 (0.96, 0.75) P=0.011), but not for the shock cohort.
CONCLUSIONS: Increased volume of trauma admissions is associated with improved trauma center survival and decreased post injury morbidity. Trauma system planning and implementation should avoid unnecessary duplication of services.
|Per 1000 patient increase||24h Mortality|
|All patients||0.87 (.77, .99)|
|0.86 (.78, .96)|
|0.62 (.30, .93)|
|-0.32 (-.57, -.07)|
|Shock cohort||0.93 (.80, 1.07)|
|0.96 (.85, 1.09)|
|-0.05 (-.43, .32)|
|0.1 (-.18, .38)|
|TBI only cohort||0.85 (.75, .97)|
|0.84 (.75, .93)|
|1.00 (.57, 1.42)|
|-0.55 (-.87, -.23)|
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