Right hospital, right patients: Penetrating injury patients treated at high-volume penetrating trauma centers have lower mortality

Abstract

BACKGROUND The recognition of the relationship between volume and outcomes led to the regionalization of trauma care. The relationship between trauma mechanism-subtype and outcomes has yet to be explored. We hypothesized that trauma centers with a high volume of penetrating trauma patients might be associated with a higher survival rate for penetrating trauma patients. METHODS A retrospective cohort analysis of penetrating trauma patients presenting between 2011 and 2015 was conducted using the National Trauma Database and the trauma registry at the Stroger Cook County Hospital. Linear regression was used to determine the relationship between mortality and the annual volume of penetrating trauma seen by the treating hospital. RESULTS Nationally, penetrating injuries account for 9.5% of the trauma cases treated. Patients treated within the top quartile penetrating-volume hospitals (≥167 penetrating cases per annum) are more severely injured (Injury Severity Score: 8.9 vs. 7.7) than those treated at the lowest quartile penetrating volume centers (<36.6 patients per annum). There was a lower mortality rate at institutions that treated high numbers of penetrating trauma patients per annum. A penetrating trauma mortality risk adjustment model showed that the volume of penetrating trauma patients was an independent factor associated with survival rate. CONCLUSION Trauma centers with high penetrating trauma patient volumes are associated with improved survival of these patients. This association with improved survival does not hold true for the total trauma volume at a center but is specific to the volume of the penetrating trauma subtype. LEVEL OF EVIDENCE Prognostic/Epidemiology Study, Level-III; Therapeutic/Care Management, Level IV.

Race and trauma mortality: The effect of hospital-level Black–White patient race distribution

“…Another possible explanation is the volume effect. Black patients were proportionally more likely to present with penetrating trauma to urban hospitals, and previous studies have shown that patients with penetrating injuries have improved survival at centers that see high volumes of these types of injuries, which are also predominantly urban centers 23–25 . It may be that H-BS hospitals, which see a greater number of younger Black patients with penetrating trauma, are better equipped to manage these types of traumatic injuries.…”

“…Black patients were proportionally more likely to present with penetrating trauma to urban hospitals, and previous studies have shown that patients with penetrating injuries have improved survival at centers that see high volumes of these types of injuries, which are also predominantly urban centers. [23][24][25] It may be that H-BS hospitals, which see a greater number of younger Black patients with penetrating trauma, are better equipped to manage these types of traumatic injuries. Hospitals characterized as L-BS have higher volumes of older patients and may, thus, be more prepared or skilled in the management of geriatric trauma, which includes more White patients.…”

After 9,000 laparotomies for blunt trauma, resuscitation is becoming more balanced and time to intervention shorter: Evidence in action

“…Only 9.5% of trauma patients treated nationally have a penetrating mechanism, and our focus on blunt trauma allows our results to reflect widespread national trends, rather than the performance of a few centers with high volumes of penetrating injury. 38 Furthermore, previous studies have demonstrated conflicting results comparing the improvements in outcomes after highratio transfusion practices in the blunt versus penetrating trauma populations. The explanation offered for the improved outcomes seen with DCR is that it prevents and corrects trauma-induced coagulopathy.…”

Ten-year in-hospital mortality trends among Japanese injured patients by age, injury severity, injury mechanism, and injury region: A nationwide observational study

“…A previous study suggested that the survival benefit in patients with severe head injury, penetrating injury, pelvic injury, and solid organ injury may be improved by centralization to trauma centers with a higher quality of trauma care [ 16 ]. Several studies have also suggested that centralizing patients with penetrating injury or pediatric injured patients to higher-volume hospitals may contribute to the survival benefit [ 17 , 18 ]. Therefore, it is necessary to achieve a trauma care system that centralizes specific severely injured patients to hospitals with a high volume and quality to improve their outcomes, based on the results of a nationwide clinical research based on the injury mechanism and region.…”