title: Is outcome after blunt splenic injury in adults better in high-volume trauma centers?
abstract: An association between outcome and case volume has been demonstrated for selected complex operations. The relationship between trauma center volume and patient outcome has also been examined, but no clear consensus has been established. The American College of Surgeons (ACS) has published recommendations on optimal trauma center volume for level 1 designation. We examined whether this volume criteria was associated with outcome differences for the treatment of adult blunt splenic injuries. Using a state trauma database, ACS criteria were used to stratify trauma centers into high-volume centers (>240 patients with Injury Severity Score >15 per year) or low-volume centers, and outcome was evaluated. There were 1,829 patients treated at high-volume centers and 1,040 patients treated at low-volume centers. There was no difference in age, gender, emergency department pulse, emergency department systolic blood pressure, or overall mortality between high- and low-volume centers. Patients at low-volume centers were more likely to be treated operatively, but the overall success rate of nonoperative management between high- and low-volume centers was similar. These data suggest that ACS criteria for trauma centers level designation are not associated with differences in outcome in the treatment of adult blunt splenic injuries in this regional trauma system.
authors.affiliation: Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
authors.forename: Brian G
authors.initials: BG
authors.lastname: Harbrecht
authors.forename: Mazen S
authors.initials: MS
authors.lastname: Zenati
authors.forename: Louis H
authors.initials: LH
authors.lastname: Alarcon
authors.forename: Juan B
authors.initials: JB
authors.lastname: Ochoa
authors.forename: Juan C
authors.initials: JC
authors.lastname: Puyana
authors.forename: Vaishali D
authors.initials: VD
authors.lastname: Schuchert
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Peitzman
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries*; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014949:Wounds, Nonpenetrating / Q000628:therapy*