title: Increased trauma center volume is associated with improved survival after severe injury: results of a Resuscitation Outcomes Consortium study.
abstract: OBJECTIVE
  To investigate the relationship between trauma center volume and outcome.
  
  
  BACKGROUND
  The Resuscitation Outcomes Consortium is a network of 11 centers and 60 hospitals conducting emergency care research. For many procedures, high-volume centers demonstrate superior outcomes versus low-volume centers. This remains controversial for trauma center outcomes.
  
  
  METHODS
  This study was a secondary analysis of prospectively collected data from the Resuscitation Outcomes Consortium multicenter out-of-hospital Hypertonic Saline Trial in patients with Glasgow Coma Scale score of 8 or less (traumatic brain injury) or systolic blood pressure of 90 or less and pulse of 110 or more (shock). Regression analyses evaluated associations between trauma volume and the following outcomes: 24-hour mortality, 28-day mortality, ventilator-free days, Multiple Organ Dysfunction Scale incidence, worst Multiple Organ Dysfunction Scale score, and poor 6-month Glasgow Outcome Scale-Extended score.
  
  
  RESULTS
  A total of 2070 patients were evaluated: 1251 in the traumatic brain injury cohort and 819 in the shock cohort. Overall, 24-hour and 28-day mortality was 16% and 25%, respectively. For every increase of 500 trauma center admissions, there was a 7% decreased odds of 24-hour and 28-day mortality for all patients. As trauma center volume increased, nonorgan dysfunction complications increased, ventilator-free days increased, and worst Multiple Organ Dysfunction Scale score decreased. The associations with higher trauma center volume were similar for the traumatic brain injury cohort, including better neurologic outcomes at 6 months, but not for the shock cohort.
  
  
  CONCLUSIONS
  Increased trauma center volume was associated with increased survival, more ventilator-free days, and less severe organ failure. Trauma system planning and implementation should avoid unnecessary duplication of services.
authors.affiliation: *Department of Surgery, University of Texas Southwestern Medical Center, Dallas †Department of Surgery, University of Tennessee Health Science Center, Memphis ‡Department of Biostatistics, University of Washington, Seattle §Department of Emergency Medicine, Oregon Health & Science University, Portland ‖Department of Surgery, University of Washington, Seattle ¶Department of Surgery, Medical College of Wisconsin, Milwaukee **Department of Surgery, University of Pittsburgh, Pittsburgh ††Department of Medicine, University of Toronto, Toronto, Ontario, Canada; and Ornge Transport Medicine, Mississauga, Ontario, Canada; for the Resuscitation Outcome Consortium Investigators.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Minei
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Fabian
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Guffey
authors.forename: Craig D
authors.initials: CD
authors.lastname: Newgard
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Bulger
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Brasel
authors.forename: Jason L
authors.initials: JL
authors.lastname: Sperry
authors.forename: Russell D
authors.initials: RD
authors.lastname: MacDonald
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000401:mortality*; D005260:Female; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D009102:Multiple Organ Failure / Q000401:mortality; D017063:Outcome Assessment, Health Care; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012771:Shock, Hemorrhagic / Q000401:mortality*; D016019:Survival Analysis; D014193:Trauma Centers / Q000458:organization & administration / Q000706:statistics & numerical data*; D015599:Trauma Severity Indices