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Impact of trauma centre capacity and volume on the mortality risk of incoming new admissions.

Publication ,  Journal Article
Chiu, WC; Powers, DB; Hirshon, JM; Shackelford, SA; Hu, PF; Chen, SY; Chen, HH; Mackenzie, CF; Miller, CH; DuBose, JJ; Carroll, C; Fang, R; Scalea, TM
Published in: BMJ Mil Health
June 2022

INTRODUCTION: Trauma centre capacity and surge volume may affect decisions on where to transport a critically injured patient and whether to bypass the closest facility. Our hypothesis was that overcrowding and high patient acuity would contribute to increase the mortality risk for incoming admissions. METHODS: For a 6-year period, we merged and cross-correlated our institutional trauma registry with a database on Trauma Resuscitation Unit (TRU) patient admissions, movement and discharges, with average capacity of 12 trauma bays. The outcomes of overall hospital and 24 hours mortality for new trauma admissions (NEW) were assessed by multivariate logistic regression. RESULTS: There were 42 003 (mean=7000/year) admissions having complete data sets, with 36 354 (87%) patients who were primary trauma admissions, age ≥18 and survival ≥15 min. In the logistic regression model for the entire cohort, NEW admission hospital mortality was only associated with NEW admission age and prehospital Glasgow Coma Scale (GCS) and Shock Index (SI) (all p<0.05). When TRU occupancy reached ≥16 patients, the factors associated with increased NEW admission hospital mortality were existing patients (TRU >1 hour) with SI ≥0.9, recent admissions (TRU ≤1 hour) with age ≥65, NEW admission age and prehospital GCS and SI (all p<0.05). CONCLUSION: The mortality of incoming patients is not impacted by routine trauma centre overcapacity. In conditions of severe overcrowding, the number of admitted patients with shock physiology and a recent surge of elderly/debilitated patients may influence the mortality risk of a new trauma admission.

Duke Scholars

Published In

BMJ Mil Health

DOI

EISSN

2633-3775

Publication Date

June 2022

Volume

168

Issue

3

Start / End Page

212 / 217

Location

England

Related Subject Headings

  • Trauma Centers
  • Resuscitation
  • Humans
  • Hospitalization
  • Hospital Mortality
  • Glasgow Coma Scale
  • Aged
 

Citation

APA
Chicago
ICMJE
MLA
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Chiu, W. C., Powers, D. B., Hirshon, J. M., Shackelford, S. A., Hu, P. F., Chen, S. Y., … Scalea, T. M. (2022). Impact of trauma centre capacity and volume on the mortality risk of incoming new admissions. BMJ Mil Health, 168(3), 212–217. https://doi.org/10.1136/bmjmilitary-2020-001483
Chiu, William C., D. B. Powers, J. M. Hirshon, S. A. Shackelford, P. F. Hu, S. Y. Chen, H. H. Chen, et al. “Impact of trauma centre capacity and volume on the mortality risk of incoming new admissions.BMJ Mil Health 168, no. 3 (June 2022): 212–17. https://doi.org/10.1136/bmjmilitary-2020-001483.
Chiu WC, Powers DB, Hirshon JM, Shackelford SA, Hu PF, Chen SY, et al. Impact of trauma centre capacity and volume on the mortality risk of incoming new admissions. BMJ Mil Health. 2022 Jun;168(3):212–7.
Chiu, William C., et al. “Impact of trauma centre capacity and volume on the mortality risk of incoming new admissions.BMJ Mil Health, vol. 168, no. 3, June 2022, pp. 212–17. Pubmed, doi:10.1136/bmjmilitary-2020-001483.
Chiu WC, Powers DB, Hirshon JM, Shackelford SA, Hu PF, Chen SY, Chen HH, Mackenzie CF, Miller CH, DuBose JJ, Carroll C, Fang R, Scalea TM. Impact of trauma centre capacity and volume on the mortality risk of incoming new admissions. BMJ Mil Health. 2022 Jun;168(3):212–217.

Published In

BMJ Mil Health

DOI

EISSN

2633-3775

Publication Date

June 2022

Volume

168

Issue

3

Start / End Page

212 / 217

Location

England

Related Subject Headings

  • Trauma Centers
  • Resuscitation
  • Humans
  • Hospitalization
  • Hospital Mortality
  • Glasgow Coma Scale
  • Aged