Abstract 204: Better Volume-Outcome Relationship in the Trauma Centers, but Not in The Regional Hospitals. A Nation-wide Population Based Research in Taiwan
Background: Survival rates for major trauma patients in different levels of hospitals were analyzed to test for the volume-outcome relationship.
Methods: From the claim data of one million beneficiaries of Taiwan National Health Insurance during the year of 2006 to 2008, all of the trauma patients were identified from the database by the ICD-9-CM system. ICD-MAP 90 was used for calculating the Injury Severity Score as the variable controlling the disease severity. The patients of major trauma were defined as ISS more than fifteen. We used patients’ diagnosis one year before trauma admission for calculating Charlson Comorbidity Index. And factors such as age, gender, ICU admission, different hospital levels and the hospital case volumes were adjusted in a logistic regression model for survival analysis.
Results: There were 5912, 5611 and 5760 trauma patients admitted from emergency department from 2006 to 2008, and there were 2497 major trauma patients (ISS more then 15). The totally mortality rate was 12.49% (6.98% in the youngest group and 18.19% in the oldest group, P<0.01). After controlling the age, genders, co-morbidity and injury severity, the difference of mortality rates were significant in hospital levels. Compared with the risk in low volume centers, the risk of mortality was 0.65 times in mid-volume trauma centers (P=0.048) and the risk of mortality was 0.43 times in high -volume trauma centers (P=0.014). But in regional hospitals, compared with the risk in low volume hospitals, the risk of mortality was 0.73 times in mid-volume regional hospitals (P=0.253) and the risk of mortality was 0.80 times in high-volume regional hospitals (P=0.354).
Conclusions: Our results suggest major trauma patients should be sent to the trauma centers. And, based on the better volume-outcome relationship in trauma centers, we should not have too many trauma centers in metropolitan area. Many trauma centers could lead to the possible dilution effect and lower the survival rates. And, based on our results, the volume-outcome relationship is not prominent in regional hospitals.
- © 2013 by American Heart Association, Inc.