Does Trauma Center Volume Matter? An Analysis of Trauma Center Volume on Outcome Using the TQIP/NTDB Database

Abstract

Background: Increasing trauma center admission volume is said to decrease mortality. Evidence supporting this position is dependent upon patient groups and the time period studied, and gaps remain. We evaluated the effect of annual volume of critically injured patients on hospital mortality, comparing two time periods. The effect of critically injured patient volume on risk-adjusted mortality was hypothesized to decrease over time. Methods: This was a retrospective cohort study comparing data from an early group (2007-2011) and late group (2017-2021) of the National Trauma Data Bank. Critically injured adults (ISS > 15) admitted to the intensive care unit (ICU) or operating room from the emergency department at Level I and II trauma centers were included. The outcome of interest was risk-adjusted mortality across quintiles of patient admission volume, modeled using mixed-effects generalized linear models. Results: In total, 802,824 patients were included, 321,209 and 481,615 in the early and late groups, respectively. In the early group, increased patient volume was associated with a decreased risk-adjusted odds of mortality. This association was not seen in the late group. The overall odds of mortality in the late group demonstrated decreased mortality over time (OR 0.84, p < 0.001). Conclusions: The annual volume of critically injured patients was associated with decreased odds of hospital mortality during 2007-2011, though this effect was no longer present in the 2017-2021 sample. The continued dissemination of the best practices is warranted to decrease mortality, regardless of the admission volume of critically injured patients.

Keywords: admission volume; trauma; trauma center verification; trauma centers; trauma systems.

Figure 1

STROBE diagram of patient exclusion by time period.