title: Relationship between pediatric blood and marrow transplant center volume and day +100 mortality: Pediatric Blood and Marrow Transplant Consortium experience.
abstract: The number of patients receiving a BMT is currently being used as a factor in the accreditation process in determining whether a center can provide a high-quality BMT. Such criteria particularly impact pediatric BMT centers as most of them perform a relatively small number of BMTs. To determine whether patient volume is a valid marker of pediatric BMT center's capabilities, the Pediatric Blood and Marrow Transplant Consortium (PBMTC) evaluated data from its registry to define the relationship between a pediatric transplant center's patient volume and day +100 mortality. The analyses evaluated 2575 transplants from 60 centers reporting to the PBMTC between the years 2002 and 2004. The volume-outcome relationship was evaluated while adjusting for 46 independent data categories divided between nine variables that were known- or suspected-mortality risk factors. We found no association between transplant center volume and day +100 mortality in several analyses. A calculated intraclass correlation coefficient also indicated that differences in individual transplant center volume contributed to only 1% of the variance in day +100 mortality within the PBMTC. The results of this study suggest that factors other than transplant center volume contribute to variation in day +100 mortality among pediatric patients.
authors.affiliation: Department of Pediatrics, University of California, Davis Children's Hospital, Sacramento, CA 95817, USA. douglas.taylor@ucdmc.ucdavis.edu
authors.forename: D S
authors.initials: DS
authors.lastname: Taylor
authors.forename: M
authors.initials: M
authors.lastname: Dharmar
authors.forename: E
authors.initials: E
authors.lastname: Urquhart-Scott
authors.forename: R
authors.initials: R
authors.lastname: Ryan
authors.forename: M A
authors.initials: MA
authors.lastname: Pulsipher
authors.forename: A
authors.initials: A
authors.lastname: Gamis
authors.forename: K
authors.initials: K
authors.lastname: Schultz
authors.forename: J P
authors.initials: JP
authors.lastname: Marcin
mesh_terms: D000068:Accreditation; D000293:Adolescent; D016026:Bone Marrow Transplantation / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors