The volume-outcomes relationship for United States Level I trauma centers.

BACKGROUND: Previous studies of the center volume-outcomes relationship for severe trauma care have yielded conflicting findings regarding the presence or nature of such a relationship. Few studies have confined their analysis to Level I centers. METHODS: We performed a retrospective analysis of severely injured adults treated from 2001 through 2006 in United States Level I trauma centers using data from the National Trauma Data Bank version 7.1. The post-injury in-hospital mortality rates for patients treated at high- or medium-volume Level I trauma centers were compared with the rates for patients treated at low-volume Level I centers before and after adjustment for patient demographic and injury characteristics. Subgroup comparisons were performed for those Level I centers with and without American College of Surgeons (ACS) verification of Level I designation. RESULTS: Overall, medium-volume Level I trauma centers had significantly lower mortality than low-volume centers (14.3% versus 15.6%), both before and after adjustment for patient demographic and injury characteristics. Of those trauma centers without ACS verification of Level I designation, high-volume centers had significantly greater mortality than low-volume centers. CONCLUSIONS: Our findings support the current utilization by the American College of Surgeons of minimum annual volume requirements for the verification of Level I trauma center designation, and suggest that the presence of such verification may enable Level I centers to effectively manage high volume of severely injured adult patients.

Duke Scholars

Author Steven Nicholas Vaslef Trauma, Acute, and Critical Care Surgery

Author Theodore N. Pappas Surgery, Minimally Invasive Surgery