The volume-outcome relationship among severely injured patients admitted to English major trauma centres: a registry study

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Charlie A SewaltHester F Lingsma

Abstract

Many countries have centralized and dedicated trauma centres with high volumes of trauma patients. However, the volume-outcome relationship in severely injured patients (Injury Severity Score (ISS) > 15) remains unclear. The aim of this study was to determine the association between hospital volume and outcomes in Major Trauma Centres (MTCs). A retrospective observational cohort study was conducted using the Trauma Audit and Research Network (TARN) consisting of all English Major Trauma Centres (MTCs). Severely injured patients (ISS > 15) admitted to a MTC between 2013 and 2016 were included. The effect of hospital volume on outcome was analysed with random effects logistic regression models with a random intercept for centre and was tested for nonlinearity. Primary outcome was in-hospital mortality. A total of 47,157 severely injured patients from 28 MTCs were included in this study. Hospital volume varied from 69 to 781 severely injured patients per year. There were small between-centre differences in mortality after adjusting for important demographic and injury severity characteristics (adjusted 95% odds ratio range: 0.99-1.01). Hospital volume was found to be linear and not associated with in-hospital mortality (adjusted o...Continue Reading

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Citations

Oct 8, 2020·Journal of Clinical Medicine·Roberto BiniOsvaldo Chiara
May 1, 2021·Journal of Clinical Medicine·Charlie A Sewalt On Behalf Of Ltr Research Group

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Methods Mentioned

BETA
ISS

Software Mentioned

lme4
R
R Foundation for Statistical Computation

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