Sewalt Charlie A, Venema Esmee, van Zwet Erik, van Ditshuizen Jan C, Schuit Stephanie C E, Polinder Suzanne, Lingsma Hester F, den Hartog Dennis
Department of Public Health, Erasmus MC Medical Center, 3015 GD Rotterdam, The Netherlands.
Department of Neurology, Erasmus MC Medical Center, 3015 GD Rotterdam, The Netherlands.
J Clin Med. 2021 Apr 15;10(8):1700. doi: 10.3390/jcm10081700.
Centralization of trauma centers leads to a higher hospital volume of severely injured patients (Injury Severity Score (ISS) > 15), but the effect of volume on outcome remains unclear. The aim of this study was to determine the association between hospital volume of severely injured patients and in-hospital mortality in Dutch Level-1 trauma centers. A retrospective observational cohort study was performed using the Dutch trauma registry. All severely injured adults (ISS > 15) admitted to a Level-1 trauma center between 2015 and 2018 were included. The effect of hospital volume on in-hospital mortality was analyzed with random effects logistic regression models with a random intercept for Level-1 trauma center, adjusted for important demographic and injury characteristics. A total of 11,917 severely injured patients from 13 Dutch Level-1 trauma centers was included in this study. Hospital volume varied from 120 to 410 severely injured patients per year. Observed mortality rates varied between 12% and 24% per center. After case-mix correction, no statistically significant differences between low- and high-volume centers were demonstrated (adjusted odds ratio 0.97 per 50 extra patients per year, 95% Confidence Interval 0.90-1.04, = 0.44). The variation in hospital volume of the included Level-1 trauma centers was not associated with the outcome of severely injured patients. Our results suggest that well-organized trauma centers with a similar organization of care could potentially achieve comparable outcomes.
创伤中心的集中化导致严重受伤患者（损伤严重度评分（ISS）>15）的医院收治量增加，但收治量对治疗结果的影响仍不明确。本研究的目的是确定荷兰一级创伤中心严重受伤患者的医院收治量与院内死亡率之间的关联。使用荷兰创伤登记处进行了一项回顾性观察队列研究。纳入了2015年至2018年间入住一级创伤中心的所有严重受伤成人（ISS>15）。采用随机效应逻辑回归模型分析医院收治量对院内死亡率的影响，该模型具有一级创伤中心的随机截距，并对重要的人口统计学和损伤特征进行了调整。本研究共纳入了来自13个荷兰一级创伤中心的11917例严重受伤患者。各医院每年收治的严重受伤患者数量从120例至410例不等。各中心观察到的死亡率在12%至24%之间。经过病例组合校正后，低收治量中心和高收治量中心之间未显示出统计学上的显著差异（每年每增加50例患者，调整后的优势比为0.97，95%置信区间为0.90-1.04，P=0.44）。纳入的一级创伤中心的医院收治量差异与严重受伤患者的治疗结果无关。我们的结果表明，组织良好且护理组织相似的创伤中心可能会取得相当的治疗效果。
