RELATIONSHIP OF TRAUMA PATIENT VOLUME TO OUTCOME EXPERIENCE - CAN A RELATIONSHIP BE DEFINED

Objectives: Five Sears experience recorded in a multi-institutional pe diatric trauma registry was analyzed to define the relationship betwee n case volume and outcome as measured by mortality. Methods: A total o f 30,930 records with complete data were categorized by contributing h ospital. Patients with fatal injury as indicated by an injury severity score of 75 or any abbreviated injury scale of 6 were excluded. Each center's experience was stratified by injury severity using injury sev erity score greater than or equal to 15 as indicative of severe injury . Centers were then classified as low volume (LV, 100-500 cases), mid volume (MV, 501-1,000 cases), or high volume (HV, >1,000 cases), Propo rtion of patients with severe injury (injury severity score > 15) and mortality were accepted at p < 0.05. Using the Pediatric Risk Indicato r to adjust for mortality risk, the combined hospital experience of ea ch volume group was further analyzed to assess performance with specif ic levels of increasing injury severity. Results: Findings demonstrate d a trend of increasing mortality with increasing volume, despite a co nsistent proportion of severe injury, Risk adjusted mortality for each volume class indicates best outcome in the mid level group. Conclusio ns: Regardless of overall volume of patients encountered, there is a c onsistent proportion of severe injury. The increasing mortality with t he most severe injuries seen in the high volume centers may reflect ov erdemand on resources.