Relationship between trauma center volume and outcomes

Context The premise underlying regionalization of trauma care is that large r volumes of trauma patients cared for in fewer institutions will lead to i mproved outcomes. However, whether a relationship exists between institutio nal volume and trauma outcomes remains unknown. Objective To evaluate the association between trauma center volume and outc omes of trauma patients. Design Retrospective cohort study. Setting Thirty-one academic level I or level II trauma centers across the U nited States participating in the University Healthsystem Consortium Trauma Benchmarking Study. Patients Consecutive patients with penetrating abdominal injury (PAI; n=478 ) discharged between November 1, 1997, and July 31, 1998, or with multisyst em blunt trauma (minimum of head injury and lower-extremity long-bone fract ures; n=541) discharged between June 1 and December 31, 1998. Main Outcome Measures Inpatient mortality and hospital length of stay (LOS) , comparing high-volume (>650 trauma admissions/y) and low-volume (less tha n or equal to 650 admissions/y) centers. Results After multivariate adjustment for patient characteristics and injur y severity, the relative odds of death was 0.02 (95% confidence interval [C I], 0.002-0.25) for patients with PAI admitted with shock to high-volume ce nters compared with low-volume centers. No benefit was evident in patients without shock (P=.50). The adjusted odds of death in patients with multisys tem blunt trauma who presented with coma to a high-volume center was 0.49 ( 95% CI, 0.26-0.93) vs low-volume centers. No benefit was observed in patien ts without coma (P=.05). Additionally, a shorter LOS was observed in patien ts with PAI and New Injury Severity Scores of 16 or higher (difference in a djusted mean LOS, 1.6 days [95% CI, -1.5 to 4.7 days]) and in all patients with multisystem blunt trauma admitted to higher-volume centers (difference in adjusted mean LOS, 3.3 days [95% CI, 0.91-5.70 days]). Conclusions Our results indicate that a strong association exists between t rauma center volume and outcomes, with significant improvements in mortalit y and LOS when volume exceeds 650 cases per year. These benefits are only e vident in patients at high risk for adverse outcomes.