ArticleAnnals of surgery2017
Impact of Volume Change Over Time on Trauma Mortality in the United States.
Article in Annals of surgery, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed.
- Volume, Expertise, and System Design: Matching Trauma Resources to Population Needs.Annals of surgery · 2026Article
- State Trauma Center Designation Criteria and Expansion of For-Profit vs Nonprofit Trauma Centers.JAMA network open · 2026Article
- Mortality During In-Hospital Stay and the First 24 h After Decompressive Craniectomy in Severe Traumatic Brain Injury: A Multi-Center, Retrospective Propensity Score-Matched Study.Journal of clinical medicine · 2025Article
- Updates on Laparoscopy Versus Laparotomy in the Management of Penetrating Abdominal Trauma: A Systematic Review.Cureus · 2025Review
- Are the life-saving interventions really life-saving?Trauma surgery & acute care open · 2025Article
- Costs of Transfer From Nontrauma to Trauma Centers Among Patients With Minor Injuries.JAMA network open · 2024Article
- Changes in payer mix of new and established trauma centers: the new trauma center money grab?Trauma surgery & acute care open · 2024Article
- Trauma Patient Volume and the Quality of Care: A Scoping Review.Journal of clinical medicine · 2023Article
- Process times of severely injured patients in the emergency room are associated with patient volume: a registry-based analysis.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2022Article
- Why do some trauma patients die while others survive? A matched-pair analysis based on data from Trauma Register DGU®.Chinese journal of traumatology = Zhonghua chuang shang za zhi · 2020Article
- Influence of trends in hospital volume over time on patient outcomes for high-risk surgery.BMC health services research · 2020Observational
- The impact of teaching status on trauma center clinical outcomes in the United States.Medicine · 2019Observational
- Defining geographic emergency medical services coverage in trauma systems.The journal of trauma and acute care surgery · 2019Article
- Development and validation of a novel prediction model to identify patients in need of specialized trauma care during field triage: design and rationale of the GOAT study.Diagnostic and prognostic research · 2019Article
- Potential impact of Affordable Care Act-related insurance expansion on trauma care reimbursement.The journal of trauma and acute care surgery · 2017Article
- A Systematic Literature Review of Trauma Systems: An Operations Management Perspective.Advances in rehabilitation science and practiceReview
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Authors and funding
9 authors.
Funding
Abstract
objectiveTo evaluate the association of trauma center volume change over time with mortality.
backgroundRegionalization of trauma systems assumes a volume-outcome relationship for severe injury. Whereas this has been shown for cross-sectional volume, it is unclear whether volume changes over time translate into predictable outcome changes.
methodsRetrospective cohort study of severely injured (injury severity score >15) patients from the National Trauma Databank 2000 to 2012. A center-level standardized mortality ratio (SMR) was constructed (ratio of observed to expected deaths). Expected mortality was obtained from multilevel logistic regression model, adjusting for demographics, mechanism, vital signs, and injury severity. Center-level percent volume change was assessed across early (2000-2006) and late (2007-2012) periods. Longitudinal panel modeling evaluated association between annual SMR change and volume change over preceding years.
resultsThere were 839,809 patients included from 287 centers. Each 1% increase in volume was associated with 73% increased odds of improving SMR over time [odds ratio (OR) 1.73; 95% confidence interval (CI) 1.03-2.91; P = 0.03]. Each 1% decrease in volume was associated with 2-fold increase in odds of worsening SMR over time (OR 2.14; 95% CI 1.07-4.26, P = 0.03). Significant improvement in the SMR emerged after 3 or more preceding years of increasing volume (SMR change -0.008; 95% CI -0.015, -0.002; P = 0.01). This benefit occurred only in centers that were level I or II verified.
conclusionsIncreasing volume was associated with improving outcomes, whereas decreasing volume was associated with worsening outcomes. High-level trauma center infrastructure seems to facilitate the volume-outcome relationship. The trauma center designation process should consider volume changes in the overall system.
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