The Relationship between Hospital Volume and In-Hospital Mortality of Severely Injured Patients in Dutch Level-1 Trauma Centers
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Volume-Outcome Relationship: In-Hospital Mortality
4. Discussion
4.1. Strengths and Limitations
4.2. Implications
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A. Participants of LTR Research Group
- F.W. Bloemers, MD, PhD, Trauma Surgery, Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands
- H.J. ten Duis, PhD, University of Groningen, the Netherlands
- M.J.R. Edwards, MD, PhD, Department of Trauma surgery, Radboud University Medical Center, Nijmegen, The Netherlands
- M.A.C. de Jongh, PhD, Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, the Netherlands
- L.P.H. Leenen, MD, PhD, Department of Trauma surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- P.A. Leenhouts, MD, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
- M. Poeze, MD, PhD, Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- I.B. Schipper, MD, PhD, Department of Trauma surgery, Leiden University Medical Center, Leiden, The Netherlands
- W.R. Spanjersberg, MD, Department of Trauma Surgery, Isala Klinieken, Zwolle, The Netherlands
- L.M. Sturms, PhD, Dutch Network Emergency Care, Utrecht, The Netherlands
- R.J. de Wit, MD, Department of Trauma Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
- K.W. Wendt, MD, PhD, Department of Trauma Surgery, University Medical Center Groningen, University of Groningen
- S. van Zutphen, MD, Department of Surgery Elisabeth Tweesteden Ziekenhuis, Tilburg, The Netherlands
Appendix B
Low Volume <180 Patients/Year (n = 3532) | High Volume ≥180 Patients/Year (n = 8385) | |
---|---|---|
Number of Level-1 trauma centers | 6 | 7 |
Mean hospital volume per year | 147 | 299 |
Age | 58 (35–74) | 53 (30–69) |
Male | 2322 (65.7%) | 5783 (69.0%) |
Penetrating injury | 130 (3.7%) | 288 (3.4%) |
ISS | 22 (17–26) | 22 (17–29) |
ISS > 24 | 1444 (40.9%) | 3869 (46.1%) |
ASA comorbidities 1-A normal healthy patient 2-A patient with mild systemic disease 3-A patient with severe systemic disease 4-A patient with severe systemic disease that is a constant threat to life | 1714 (48.5%) 1403 (39.7%) 410 (11.6%) 5 (0.1%) | 4126 (49.2%) 3037 (36.2%) 1118 (13.3%) 104 (1.2%) |
Prehospital intubation | 536 (15.2%) | 2545 (30.4%) |
GCS at arrival Emergency Department (ED) | 14 (7–15) | 13 (3–15) |
GCS < 8 | 924 (26.2%) | 2810 (33.5%) |
Respiration rate at arrival ED | 16 (14–20) | 18 (14–20) |
Systolic blood pressure at arrival ED | 134 (119–159) | 129 (113–150) |
Systolic Blood Pressure < 90 | 169 (4.8%) | 575 (6.9%) |
Cardiac arrest | 179 (5.1%) | 582 (6.9%) |
AIS head > 3 | 1515 (42.9%) | 3622 (43.2%) |
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Low Volume <180 Patients/Year (n = 3532) | High Volume ≥180 Patients/Year (n = 8385) | % Missings | |
---|---|---|---|
Number of Level-1 trauma centers | 6 | 7 | 0.0% |
Mean hospital volume per year | 147 | 299 | 0.0% |
Age | 58 (35–74) | 53 (30–69) | 0.0% |
Male | 2322 (65.7%) | 5783 (69.0%) | 0.0% |
Penetrating injury | 129 (3.7%) | 288 (3.4%) | 0.5% |
ISS | 22 (17–26) | 22 (17–29) | 0.0% |
ISS > 24 | 1444 (40.9%) | 3869 (46.1%) | 0.0% |
ASA comorbidities 1-A normal healthy patient 2-A patient with mild systemic disease 3-A patient with severe systemic disease 4-A patient with severe systemic disease that is a constant threat to life | 1251 (48.6%) 1025 (39.8%) 293 (11.4%) 4 (0.2%) | 3795 (48.9%) 2821 (36.4%) 1038 (13.4%) 103 (1.3%) | 13.3% |
Prehospital intubation | 373 (15.6%) | 2248 (31.6%) | 20.3% |
GCS at arrival Emergency Department (ED) | 14 (8–15) | 13 (3–15) | 12.2% |
GCS < 8 | 641 (24.3%) | 2631 (33.7%) | 12.2% |
Respiration rate at arrival ED | 16 (14–20) | 18 (15–20) | 29.6% |
Systolic blood pressure at arrival ED | 135 (119–157) | 130 (114–150) | 8.3% |
Systolic Blood Pressure < 90 | 147 (4.6%) | 535 (6.9%) | 8.3% |
Cardiac arrest | 114 (5.2%) | 542 (6.9%) | 15.4% |
AIS head > 3 | 1515 (42.9%) | 3622 (43.2%) | 0.0% |
Low Volume <180 Patients/Year (n = 3532) | High Volume ≥180 Patients/Year (n = 8385) | |
---|---|---|
Length of Stay | 4 (3–5) | 4 (3–5) |
ICU Length of Stay * | 3 (2–7) | 4 (2–9) |
In-hospital mortality | 580 (16.4%) | 1660 (19.8%) |
OR for 50 Patients Extra Per Year (95% CI) | p-Value | |
---|---|---|
Unadjusted | 1.04 (0.99–1.09) | 0.10 |
Adjusted | 0.97 (0.90–1.04) | 0.44 |
Complete case analysis adjusted | 1.03 (0.94–1.12) | 0.54 |
Subgroups | ||
ISS > 24 | ||
Unadjusted | 1.00 (0.89–1.12) | 0.97 |
Adjusted | 0.92 (0.80–1.05) | 0.22 |
AIS head >3 & ISS > 15 | ||
Unadjusted | 0.90 (0.75–1.08) | 0.25 |
Adjusted | 0.93 (0.79–1.09) | 0.36 |
AIS Head <4 & ISS > 15 | ||
Unadjusted | 1.05 (0.93–1.17) | 0.43 |
Adjusted | 0.92 (0.80–1.07) | 0.29 |
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Sewalt, C.A.; Venema, E.; van Zwet, E.; van Ditshuizen, J.C.; Schuit, S.C.E.; Polinder, S.; Lingsma, H.F.; den Hartog, D.; on behalf of LTR Research Group. The Relationship between Hospital Volume and In-Hospital Mortality of Severely Injured Patients in Dutch Level-1 Trauma Centers. J. Clin. Med. 2021, 10, 1700. https://doi.org/10.3390/jcm10081700
Sewalt CA, Venema E, van Zwet E, van Ditshuizen JC, Schuit SCE, Polinder S, Lingsma HF, den Hartog D, on behalf of LTR Research Group. The Relationship between Hospital Volume and In-Hospital Mortality of Severely Injured Patients in Dutch Level-1 Trauma Centers. Journal of Clinical Medicine. 2021; 10(8):1700. https://doi.org/10.3390/jcm10081700
Chicago/Turabian StyleSewalt, Charlie A., Esmee Venema, Erik van Zwet, Jan C. van Ditshuizen, Stephanie C. E. Schuit, Suzanne Polinder, Hester F. Lingsma, Dennis den Hartog, and on behalf of LTR Research Group. 2021. "The Relationship between Hospital Volume and In-Hospital Mortality of Severely Injured Patients in Dutch Level-1 Trauma Centers" Journal of Clinical Medicine 10, no. 8: 1700. https://doi.org/10.3390/jcm10081700