Outcomes/Effectiveness Research

Higher volume in trauma centers does not necessarily correlate with improved survival of trauma victims

The American College of Surgeons defines a minimum volume of trauma victims a hospital must treat in order to qualify as a level 1 or level 2 trauma center. However, higher trauma center volumes do not necessarily improve survival, according to a study supported by the Agency for Healthcare Research and Quality (K08 HS11295).

The researchers found no significant association between trauma center volume and mortality for major blunt and penetrating trauma, after adjusting for severity of injury. The volume criteria established by the American College of Surgeons for level 1 trauma centers may need to be reexamined, and the use of other process and system characteristics as the basis for trauma center designation should be considered, suggests Laurent G. Glance, M.D., of the University of Rochester Medical Center.

Dr. Glance and colleagues analyzed the volume-outcome relation for adults listed in the National Trauma Databank with a severe injury (injury severity score or ISS of 15 or more), who sustained either blunt trauma (6,274 patients) or penetrating trauma (1,097 patients). The researchers examined in-hospital survival of each group as a function of trauma center volume. After excluding patients from one outlier center, there was no association between trauma volume and outcome for blunt trauma.

A separate analysis of patients with penetrating trauma also did not show a significant volume-mortality association. Overall, 17.8 percent of patients died at trauma centers that treated less than 140 blunt trauma victims with ISS scores of 15 or more during 1999 compared with 16.6 percent in hospitals that treated 140-261 patients, 19.6 percent in hospitals that treated 262-462 patients, and 17.1 percent in hospitals that treated more than 462 patients that year; corresponding percentages of patients who died of penetrating trauma were 42.9 percent, 45 percent, 37.8 percent, and 38 percent.

See "The relation between trauma center outcome and volume in the National Trauma Databank," by Dr. Glance, Turner M. Osler, M.D., F.A.C.S., Andrew Dick, Ph.D., and Dana Mukamel, Ph.D., in the March 2004 Journal of Trauma Injury, Infection, and Critical Care 56, pp. 682-690.

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