The volume-outcome relationship among severely injured patients admitted to English major trauma centres: a registry study

Sewalt, Charlie; Wiegers, Eveline; Lecky, Fiona; Hartog, Dennis den; Schuit, Stephanie C. E.; Venema, Esmée; Lingsma, Hester F.

doi:10.1186/s13049-020-0710-7

Cited by 11 publications

(17 citation statements)

References 29 publications

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“…Our study shows that Level-1 trauma centers with a similar organization of care could potentially achieve similar results. Our findings can be extrapolated to other trauma systems and are comparable to findings from the United Kingdom [ 30 ]. Further research should include quality of life as a patient outcome, since severely injured patients suffer from long-term impairments [ 31 ].…”

Section: Discussionsupporting

confidence: 86%

The Relationship between Hospital Volume and In-Hospital Mortality of Severely Injured Patients in Dutch Level-1 Trauma Centers

Sewalt

Venema

Zwet

et al. 2021

JCM

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Centralization of trauma centers leads to a higher hospital volume of severely injured patients (Injury Severity Score (ISS) > 15), but the effect of volume on outcome remains unclear. The aim of this study was to determine the association between hospital volume of severely injured patients and in-hospital mortality in Dutch Level-1 trauma centers. A retrospective observational cohort study was performed using the Dutch trauma registry. All severely injured adults (ISS > 15) admitted to a Level-1 trauma center between 2015 and 2018 were included. The effect of hospital volume on in-hospital mortality was analyzed with random effects logistic regression models with a random intercept for Level-1 trauma center, adjusted for important demographic and injury characteristics. A total of 11,917 severely injured patients from 13 Dutch Level-1 trauma centers was included in this study. Hospital volume varied from 120 to 410 severely injured patients per year. Observed mortality rates varied between 12% and 24% per center. After case-mix correction, no statistically significant differences between low- and high-volume centers were demonstrated (adjusted odds ratio 0.97 per 50 extra patients per year, 95% Confidence Interval 0.90–1.04, p = 0.44). The variation in hospital volume of the included Level-1 trauma centers was not associated with the outcome of severely injured patients. Our results suggest that well-organized trauma centers with a similar organization of care could potentially achieve comparable outcomes.

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Section: Discussionsupporting

confidence: 86%

The Relationship between Hospital Volume and In-Hospital Mortality of Severely Injured Patients in Dutch Level-1 Trauma Centers

Sewalt

Venema

Zwet

et al. 2021

JCM

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“…Findings suggest that it is not only the patient or center characteristics that determine the differences between the centers, but that other variables, such as each teams' experience and the updating of the approach and management of the disorder, that can improve outcomes, as reported for other clinical areas, [33][34][35]. Differences in outcomes between centers that are due to different treatment policies or quality of care are undesirable, and must also be corrected by increasing adherence to guidelines.…”

Section: Discussionmentioning

confidence: 99%

Improvement of ADHD patients after 1 year from the time of diagnosis: differences between centers of a regional network

Cartabia¹,

Finazzi²,

Bonati³

2022

Preprint

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Although the pharmacological therapy of ADHD has been widely studied, little has been done to compare the different therapeutic approaches (e.g., drug therapy vs psychological treatments) and even less has been done to compare the outcome of the therapy between centers. This multicenter observational study aims to assess between-center variation in functional outcome of ADHD patients one year after the diagnosis, according to the treatment received. We used the Regional ADHD Registry data on 1429 patients enrolled in 16 ADHD centers in the 2011–2022 period. To evaluate the effectiveness of the therapy we used a generalized linear mixed model with the center as the random effect, including patient condition at diagnosis and center characteristics, weighting by the inverse of the propensity score of the treatment received by the patient. Between-center variation was expressed as the relative difference in odds-ratios between the observed and the expected number of patients whose condition improved, using the Clinical Global Impressions—Improvement Scale (CGI-I), and the relative 95% CI. Patients who received combined treatment were significantly more likely to improve compared to other treatment groups (65.5% vs 54.4% for methylphenidate alone, 53.4% for psychological treatment alone, or 40.5% for no therapy). Adjusted for patients and center characteristics, the odds ratio ranged from 0.78 (0.22–1.48 95% CI) to -0.66 (-1.12—0.24 95% CI). The mean expected probability of improvement after one year of therapy for an average patient with ADHD for each center was 47.7% in a center at the 25th percentile and 61.7% in a center at the 75th percentile of the outcome distribution after adjustments. The wide between-center variation in patient functional improvement one year after the diagnosis of ADHD could be largely explained by center-specific therapeutic approaches or attitudes. More careful and stringent adherence to the latest guidelines and evidence could reduce differences in responses between centers, as could formal and periodic audit programs within and between centers.

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“…For example, significant bodies of evidence exist concerning the optimum management of patients with traumatic brain injuries or a high total injury burden. 41–43…”

Section: Discussionmentioning

confidence: 99%

“…For example, significant bodies of evidence exist concerning the optimum management of patients with traumatic brain injuries or a high total injury burden. [41][42][43] Articles not published in English were excluded from this review which may have introduced bias against evidence from trauma systems in some high-income countries, notably in Europe and South-East Asia. Language bias against lower-to-middle-income countries is likely to be minimal because studies in these settings were explicitly excluded in the review protocol.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Is higher-level trauma center care associated with better outcomes in patients injured by low-energy trauma?

Tonkins¹,

Bradbury²,

Bramley³

et al. 2021

Preprint

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Background In high-income countries trauma patients are becoming older, more likely to have comorbidities, and are being injured by low-energy mechanisms, chiefly ground-level falls. It is currently unknown whether existing trauma systems improve the outcomes of these patients. This systematic review investigates the association between higher-level trauma center care and outcomes of adult patients who were admitted to hospital due to injuries sustained following low-energy trauma. Methods A pre-registered systematic review (CRD42020211652) of subject databases and grey literature, supplemented by targeted manual searching, was conducted in January 2021. Studies were eligible if they reported outcomes in adults admitted to hospital due to low-energy trauma. Studies were excluded if participants were not adults or were not admitted to hospital. Studies in lower- and middle-income settings were excluded due to differences in demographics and healthcare systems. Risk of bias was assessed by independent reviewers using the Robins-I tool. In the presence of study heterogeneity a narrative synthesis was pre-specified. Results Three observational studies were included from 2,898 unique records. The studies' risk of bias was moderate-to-serious due to potential residual confounding and selection bias. All studies compared outcomes among adults injured by ground-level falls treated in trauma centers verified by the American College of Surgeons in the USA. The studies reported divergent results. One demonstrated improved outcomes in level 3 or 4 trauma centers (Observed: Expected Mortality 0.973, 95%CI 0.971-0.975), one demonstrated improved outcomes in level 1 trauma centers (Adjusted Odds Ratio 0.71, 95%CI 0.56-0.91), and one demonstrated no difference between level 1 or 2 and level 3 or 4 trauma center care (Adjusted Odds Ratio 0.91 (0.80-1.04). Conclusions There is currently no strong evidence for the efficacy of major trauma centers in caring for adult patients injured by a ground-level fall. Further studies at lower risk of bias and studies conducted outwith the USA are required.

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The volume-outcome relationship among severely injured patients admitted to English major trauma centres: a registry study

Cited by 11 publications

References 29 publications

The Relationship between Hospital Volume and In-Hospital Mortality of Severely Injured Patients in Dutch Level-1 Trauma Centers

The Relationship between Hospital Volume and In-Hospital Mortality of Severely Injured Patients in Dutch Level-1 Trauma Centers

Improvement of ADHD patients after 1 year from the time of diagnosis: differences between centers of a regional network

Is higher-level trauma center care associated with better outcomes in patients injured by low-energy trauma?

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