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Impact of trauma centre capacity and volume on the mortality risk of incoming new admissions
  1. William C Chiu1,
  2. D B Powers2,
  3. J M Hirshon3,
  4. S A Shackelford4,
  5. P F Hu5,
  6. S Y Chen6,
  7. H H Chen3,
  8. C F Mackenzie7,
  9. C H Miller8,
  10. J J DuBose1,9,
  11. C Carroll10,
  12. R Fang11 and
  13. T M Scalea1
  1. 1R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
  2. 2Director, Craniomaxillofacial Trauma Program, Duke University Hospital, Durham, North Carolina, USA
  3. 3Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
  4. 4Joint Trauma System, JBSA Ft. Sam Houston, Texas, USA
  5. 5University of Maryland Medical Center, Baltimore, Maryland, USA
  6. 6National Yunlin University of Science and Technology, Douliou, Taiwan
  7. 7Shock Trauma and Anesthesiology Research - Organized Research Center (STAR-ORC), University of Maryland School of Medicine, Baltimore, Maryland, USA
  8. 8US Air Force Materiel Command, Wright-Patterson AFB, Ohio, USA
  9. 9Center for Sustainment of Trauma and Readiness Skills - Baltimore, US Air Force Medical Service, Baltimore, Maryland, USA
  10. 10Baltimore, Maryland, USA
  11. 11Surgery, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
  1. Correspondence to Dr D B Powers, Director, Craniomaxillofacial Trauma Program, Duke University Hospital, Durham, NC 27710, USA; David.Powers{at}duke.edu

Abstract

Introduction Trauma centre capacity and surge volume may affect decisions on where to transport a critically injured patient and whether to bypass the closest facility. Our hypothesis was that overcrowding and high patient acuity would contribute to increase the mortality risk for incoming admissions.

Methods For a 6-year period, we merged and cross-correlated our institutional trauma registry with a database on Trauma Resuscitation Unit (TRU) patient admissions, movement and discharges, with average capacity of 12 trauma bays. The outcomes of overall hospital and 24 hours mortality for new trauma admissions (NEW) were assessed by multivariate logistic regression.

Results There were 42 003 (mean=7000/year) admissions having complete data sets, with 36 354 (87%) patients who were primary trauma admissions, age ≥18 and survival ≥15 min. In the logistic regression model for the entire cohort, NEW admission hospital mortality was only associated with NEW admission age and prehospital Glasgow Coma Scale (GCS) and Shock Index (SI) (all p<0.05). When TRU occupancy reached ≥16 patients, the factors associated with increased NEW admission hospital mortality were existing patients (TRU >1 hour) with SI ≥0.9, recent admissions (TRU ≤1 hour) with age ≥65, NEW admission age and prehospital GCS and SI (all p<0.05).

Conclusion The mortality of incoming patients is not impacted by routine trauma centre overcapacity. In conditions of severe overcrowding, the number of admitted patients with shock physiology and a recent surge of elderly/debilitated patients may influence the mortality risk of a new trauma admission.

  • trauma management
  • surgery
  • epidemiology
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Footnotes

  • Presented at Poster presented at the 118th Annual Continuing Education Meeting of the Association of Military Surgeons of the United States (AMSUS), the Society of Federal Health Professionals, November 5, 2013, Seattle, Washington.

  • Contributors WCC: contributed to literature search, study design, data collection, data analysis, data interpretation, writing and critical revision. JMH and SAS: contributed to study design, data analysis, data interpretation and critical revision. PFH, S-YC and HHC: contributed to study design, data collection, data analysis, statistical analysis, data interpretation and critical revision. CFM and CHM: contributed to data analysis, data interpretation and critical revision. DBP, JJD and CC: contributed to literature search, study design and critical revision. RF and TMS: contributed to data interpretation and critical revision. DBP and JJD: contributed to funding from United States Air Force/Air Force Material Command

  • Funding This material is based on a research grant sponsored by the United States Air Force / Air Force Materiel Command (USAF/AFMC) 711th Human Performance Wing (711 HPW/XPT) under Cooperative Agreement number FA8650-11-2-6142, entitled 'Expeditionary Medicine, Trauma, and En Route Care (EMTEC) Research and Technology Support,' and all Agreement Orders placed under this Cooperative Agreement Award number FA8650-11-2-6D03. The US government is authorised to reproduce and distribute reprints for governmental purposes notwithstanding any copyright notation thereon.

  • Disclaimer The views and conclusions contained herein are those of the authors and should not be interpreted as necessarily representing the official policies or endorsements, either expressed or implied, of the United States Air Force, the Department of Defense, or the U.S. Government.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The protocol and procedures for this current project were approved by both the University of Maryland Baltimore (HP-00049488, Trauma Injury and Evacuation Timeline) and the Air Force Research Laboratory (FWR20110164H, Traumatic Injury and Medical Evacuation - Patient Outcomes) Institutional Review Boards.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information. All data from randomised/anonymous patient identification numbers.

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