Correlation between Hospital Volume of Severely Injured Patients and In-Hospital Mortality of Severely Injured Pediatric Patients in Japan: A Nationwide 5-Year Retrospective Study
Appropriate trauma care systems, suitable for children are needed; thus, this retrospective nationwide study evaluated the correlation between the annual total hospital volume of severely injured patients and in-hospital mortality of severely injured pediatric patients (SIPP) and compared clinical p...
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Published in | Journal of clinical medicine Vol. 10; no. 7; p. 1422 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
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01.04.2021
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Abstract | Appropriate trauma care systems, suitable for children are needed; thus, this retrospective nationwide study evaluated the correlation between the annual total hospital volume of severely injured patients and in-hospital mortality of severely injured pediatric patients (SIPP) and compared clinical parameters and outcomes per hospital between low- and high-volume hospitals. During the five-year study period, we enrolled 53,088 severely injured patients (Injury Severity Score, ≥16); 2889 (5.4%) were pediatric patients aged <18 years. Significant Spearman correlation analysis was observed between numbers of total patients and SIPP per hospital (
< 0.001), and the number of SIPP per hospital who underwent interhospital transportation and/or urgent treatment was correlated with the total number of severely injured patients per hospital. Actual in-hospital mortality, per hospital, of SIPP patients was significantly correlated with the total number patients per hospital (
< 0.001,). The total number of SIPP, requiring urgent treatment, was higher in the high-volume than in the low-volume hospital group. No significant differences in actual in-hospital morality (
= 0.246, 2.13 (0-8.33) vs. 0 (0-100)) and standardized mortality ratio (SMR) values (
= 0.244, 0.31 (0-0.79) vs. 0 (0-4.87)) were observed between the two groups; however, the 13 high-volume hospitals had an SMR of <1.0. Centralizing severely injured patients, regardless of age, to a higher volume hospital might contribute to survival benefits of SIPP. |
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AbstractList | Appropriate trauma care systems, suitable for children are needed; thus, this retrospective nationwide study evaluated the correlation between the annual total hospital volume of severely injured patients and in-hospital mortality of severely injured pediatric patients (SIPP) and compared clinical parameters and outcomes per hospital between low- and high-volume hospitals. During the five-year study period, we enrolled 53,088 severely injured patients (Injury Severity Score, ≥16); 2889 (5.4%) were pediatric patients aged <18 years. Significant Spearman correlation analysis was observed between numbers of total patients and SIPP per hospital (
p
< 0.001), and the number of SIPP per hospital who underwent interhospital transportation and/or urgent treatment was correlated with the total number of severely injured patients per hospital. Actual in-hospital mortality, per hospital, of SIPP patients was significantly correlated with the total number patients per hospital (
p
< 0.001,). The total number of SIPP, requiring urgent treatment, was higher in the high-volume than in the low-volume hospital group. No significant differences in actual in-hospital morality (
p
= 0.246, 2.13 (0–8.33) vs. 0 (0–100)) and standardized mortality ratio (SMR) values (
p
= 0.244, 0.31 (0–0.79) vs. 0 (0–4.87)) were observed between the two groups; however, the 13 high-volume hospitals had an SMR of <1.0. Centralizing severely injured patients, regardless of age, to a higher volume hospital might contribute to survival benefits of SIPP. Appropriate trauma care systems, suitable for children are needed; thus, this retrospective nationwide study evaluated the correlation between the annual total hospital volume of severely injured patients and in-hospital mortality of severely injured pediatric patients (SIPP) and compared clinical parameters and outcomes per hospital between low- and high-volume hospitals. During the five-year study period, we enrolled 53,088 severely injured patients (Injury Severity Score, ≥16); 2889 (5.4%) were pediatric patients aged <18 years. Significant Spearman correlation analysis was observed between numbers of total patients and SIPP per hospital ( < 0.001), and the number of SIPP per hospital who underwent interhospital transportation and/or urgent treatment was correlated with the total number of severely injured patients per hospital. Actual in-hospital mortality, per hospital, of SIPP patients was significantly correlated with the total number patients per hospital ( < 0.001,). The total number of SIPP, requiring urgent treatment, was higher in the high-volume than in the low-volume hospital group. No significant differences in actual in-hospital morality ( = 0.246, 2.13 (0-8.33) vs. 0 (0-100)) and standardized mortality ratio (SMR) values ( = 0.244, 0.31 (0-0.79) vs. 0 (0-4.87)) were observed between the two groups; however, the 13 high-volume hospitals had an SMR of <1.0. Centralizing severely injured patients, regardless of age, to a higher volume hospital might contribute to survival benefits of SIPP. Appropriate trauma care systems, suitable for children are needed; thus, this retrospective nationwide study evaluated the correlation between the annual total hospital volume of severely injured patients and in-hospital mortality of severely injured pediatric patients (SIPP) and compared clinical parameters and outcomes per hospital between low- and high-volume hospitals. During the five-year study period, we enrolled 53,088 severely injured patients (Injury Severity Score, ≥16); 2889 (5.4%) were pediatric patients aged <18 years. Significant Spearman correlation analysis was observed between numbers of total patients and SIPP per hospital (p < 0.001), and the number of SIPP per hospital who underwent interhospital transportation and/or urgent treatment was correlated with the total number of severely injured patients per hospital. Actual in-hospital mortality, per hospital, of SIPP patients was significantly correlated with the total number patients per hospital (p < 0.001,). The total number of SIPP, requiring urgent treatment, was higher in the high-volume than in the low-volume hospital group. No significant differences in actual in-hospital morality (p = 0.246, 2.13 (0–8.33) vs. 0 (0–100)) and standardized mortality ratio (SMR) values (p = 0.244, 0.31 (0–0.79) vs. 0 (0–4.87)) were observed between the two groups; however, the 13 high-volume hospitals had an SMR of <1.0. Centralizing severely injured patients, regardless of age, to a higher volume hospital might contribute to survival benefits of SIPP. |
Author | Toida, Chiaki Muguruma, Takashi Morimura, Naoto Gakumazawa, Masayasu Abe, Takeru Shinohara, Mafumi Takeuchi, Ichiro |
AuthorAffiliation | 2 Department of Emergency Medicine, Graduate School of Medicine, Yokohama City University, 4-57 Urafunecho, Minami-ku, Yokohama 232-0024, Japan; mgrmtks@gmail.com (T.M.); gakumazawa-tuk@umin.ac.jp (M.G.); shinoharamafumi@yahoo.co.jp (M.S.); abet@yokohama-cu.ac.jp (T.A.); takeqq@yokohama-cu.ac.jp (I.T.) 1 Department of Disaster Medical Management, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; molimula-tky@umin.ac.jp |
AuthorAffiliation_xml | – name: 1 Department of Disaster Medical Management, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; molimula-tky@umin.ac.jp – name: 2 Department of Emergency Medicine, Graduate School of Medicine, Yokohama City University, 4-57 Urafunecho, Minami-ku, Yokohama 232-0024, Japan; mgrmtks@gmail.com (T.M.); gakumazawa-tuk@umin.ac.jp (M.G.); shinoharamafumi@yahoo.co.jp (M.S.); abet@yokohama-cu.ac.jp (T.A.); takeqq@yokohama-cu.ac.jp (I.T.) |
Author_xml | – sequence: 1 givenname: Chiaki orcidid: 0000-0003-4551-4841 surname: Toida fullname: Toida, Chiaki organization: Department of Emergency Medicine, Graduate School of Medicine, Yokohama City University, 4-57 Urafunecho, Minami-ku, Yokohama 232-0024, Japan – sequence: 2 givenname: Takashi surname: Muguruma fullname: Muguruma, Takashi organization: Department of Emergency Medicine, Graduate School of Medicine, Yokohama City University, 4-57 Urafunecho, Minami-ku, Yokohama 232-0024, Japan – sequence: 3 givenname: Masayasu surname: Gakumazawa fullname: Gakumazawa, Masayasu organization: Department of Emergency Medicine, Graduate School of Medicine, Yokohama City University, 4-57 Urafunecho, Minami-ku, Yokohama 232-0024, Japan – sequence: 4 givenname: Mafumi surname: Shinohara fullname: Shinohara, Mafumi organization: Department of Emergency Medicine, Graduate School of Medicine, Yokohama City University, 4-57 Urafunecho, Minami-ku, Yokohama 232-0024, Japan – sequence: 5 givenname: Takeru surname: Abe fullname: Abe, Takeru organization: Department of Emergency Medicine, Graduate School of Medicine, Yokohama City University, 4-57 Urafunecho, Minami-ku, Yokohama 232-0024, Japan – sequence: 6 givenname: Ichiro surname: Takeuchi fullname: Takeuchi, Ichiro organization: Department of Emergency Medicine, Graduate School of Medicine, Yokohama City University, 4-57 Urafunecho, Minami-ku, Yokohama 232-0024, Japan – sequence: 7 givenname: Naoto surname: Morimura fullname: Morimura, Naoto organization: Department of Disaster Medical Management, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan |
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CitedBy_id | crossref_primary_10_1371_journal_pone_0272573 crossref_primary_10_1136_bmjopen_2023_071873 crossref_primary_10_3390_jcm12165317 crossref_primary_10_1097_TA_0000000000003838 |
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Keywords | severely injured patient pediatric patient hospital volume volume–outcome relationship centralization |
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StartPage | 1422 |
SubjectTerms | Blood transfusions Clinical medicine Correlation analysis Injuries Mortality Ostomy Patient admissions Pediatrics Surgery Trauma Trauma care Trauma centers |
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Title | Correlation between Hospital Volume of Severely Injured Patients and In-Hospital Mortality of Severely Injured Pediatric Patients in Japan: A Nationwide 5-Year Retrospective Study |
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