The Relationship between Hospital Volume and In-Hospital Mortality of Severely Injured Patients in Dutch Level-1 Trauma Centers

• Published in: Journal of clinical medicine Vol. 10; no. 8; p. 1700
• Main Authors: Sewalt, Charlie A, Venema, Esmee, van Zwet, Erik, van Ditshuizen, Jan C, Schuit, Stephanie C E, Polinder, Suzanne, Lingsma, Hester F, den Hartog, Dennis, On Behalf Of Ltr Research Group
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 15.04.2021; MDPI
• Subjects: Age; centralization; Clinical medicine; Clinical outcomes; Injuries; major trauma; Mortality; Patients; Trauma; Trauma care; Trauma centers; Variables; volume-outcome relationship; United States > US; Netherlands; major trauma; volume-outcome relationship; centralization
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm10081700

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, = 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.