Increases in volume in trauma centers can improve survival rates

Researchers from the University of Pittsburgh School of Medicine have found as the number of patients admitted into trauma centers increases, the number of patients dying decreases twofold.

Published in the Annals of Surgery journal, the study focused on the effects the volume of patients admitted in trauma center has on whether an injured patient lives or dies. The information collected is meant to help determine where a new trauma center should be built in a community based on the number of patients that can be seen without effecting patient care.

"It takes about three years for the impact of increased patient volume to translate into improved patient outcomes," said lead author Joshua Brown, MD, MS, a research fellow in the Division of Trauma and General Surgery in the Pitt School of Medicine's Department of Surgery. "Siphoning of patients through unregulated growth of unnecessary trauma centers can have a profound detrimental impact on patients that isn't immediately obvious. Before designating a new trauma center, serious consideration should be given to how that designation will affect patient volumes over time at trauma centers throughout the region."

Analyzing over 840,000 records of seriously injured patients admitted to 287 trauma centers over a 12-year period, researchers compared the expected death rate if everything went perfectly to the centers actual death rate. Results showed that for every 1 percent increase in the amount of patients admitted, patients had a 73 percent better rate of survival. The opposite was found when the volume decreased, leading to a two-fold increase in the rate of death for patients.

"So, the study suggests the negative impact of declining patient volume is significantly greater than that of the positive impact of increasing patient volume," said senior author Jason Sperry, MD, MPH, associate professor in the Pitt School of Medicine Departments of Surgery and Critical Care Medicine. "Granting unnecessary designation to a trauma center in a region that doesn't have the patient volume to support it not only hurts patient outcomes at that new center, but it will likely lead to a decline in patient outcomes at other nearby centers."