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

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • 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 Date

  • June 2022

Published In

Volume / Issue

  • 168 / 3

Start / End Page

  • 212 - 217

PubMed ID

  • 32474436

Electronic International Standard Serial Number (EISSN)

  • 2633-3775

Digital Object Identifier (DOI)

  • 10.1136/bmjmilitary-2020-001483

Language

  • eng

Conference Location

  • England