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Too Many Trauma Centers Can Lower Volumes, Increase Death Rates

PITTSBURGH – New research finding that higher patient volume improves outcomes emphasizes the importance of taking that into consideration when designating a new trauma center in a region.

A study published in Annals of Surgery finds, for the first time, that changes over time in the volume of patients seen by trauma centers can influence the survival of seriously injured patients.

"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 University of Pittsburgh 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."

For the study, researchers examined records of nearly 840,000 seriously injured patients seen at 287 trauma centers between 2000 and 2012. The centers averaged 247 severely injured patients per year, and 90% of the cases involved blunt injury.

The researchers compared the center’s actual death rate to the expected death rate if everything involving each trauma patient's care had gone perfectly.

Results indicate that each 1.0% increase in patient volume at a trauma center was associated with 73% better odds of a patient surviving. At the same time, each 1.0% decrease in volume was linked to a two-fold worsening in the odds of a patient surviving.

"So, the study suggests the negative impact of declining patient volume is significantly greater than that of the positive impact of increasing patient volume," explained senior author Jason Sperry, MD, MPH. "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."

While study authors concede that they don’t fully understand how patient volume is linked to outcomes, they theorize that, as trauma centers increase their number of patients, they also increase their resources, infrastructure, and experience.

That might not be the full explanation, however.

"Taking care of patients who sustain complex traumatic injuries is a truly multidisciplinary effort, so it requires an institutional-level commitment of resources and staff," Brown pointed out in a University of Pittsburgh Schools of the Health Sciences press release. "There are many dynamics at play here that make the issue more involved than simply increased opportunity to hone surgical skills."