Evidence map›Paper›PMID 29330633›Full record

ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2019

A seven-center examination of the relationship between monthly volume and mortality in trauma: a hypothesis-generating study.

Stanislaw P Stawicki, Keith Habeeb, Niels D Martin, M Shay O'Mara, James Cipolla, David C Evans, Creagh Boulger, Babak Sarani, Charles H Cook, Alok Gupta and 5 more

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

  1. Article
  2. 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 · 2022
    Article
  3. Article
  4. Article
  5. What's New in Critical Illness and Injury Science?:International journal of critical illness and injury science
    Article
  6. Article
  7. Operating room trauma simulation: The St. Luke's University Health Network experience.International journal of critical illness and injury science
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Stanislaw P StawickiLevel I Regional Trauma Center, St. Luke's University Health Network, Bethlehem, PA, USA. stanislaw.stawicki@sluhn.org.
Keith HabeebLevel I Regional Trauma Center, St. Luke's University Health Network, Bethlehem, PA, USA.
Niels D MartinDivision of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Penn Presbyterian Medical Center, Philadelphia, PA, USA.
M Shay O'MaraGrant Level I Trauma, OhioHealth Grant Medical Center, Columbus, OH, USA.
James CipollaLevel I Regional Trauma Center, St. Luke's University Health Network, Bethlehem, PA, USA.
David C EvansDivision of Trauma, Critical Care and Burn, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.
Creagh BoulgerDepartment of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
Babak SaraniDepartment of Surgery, Center for Trauma and Critical Care, George Washington School of Medicine and Health Sciences, Washington, DC, USA.
Charles H CookDivision of Acute Care Surgery, Trauma and Surgical Critical Care, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Alok GuptaDivision of Acute Care Surgery, Trauma and Surgical Critical Care, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
William S HoffLevel I Regional Trauma Center, St. Luke's University Health Network, Bethlehem, PA, USA.
Peter G ThomasLevel I Regional Trauma Center, St. Luke's University Health Network, Bethlehem, PA, USA.
Jeffrey M JordanDivision of Trauma/Critical Care, Department of Surgery, The State University of New York, Buffalo, NY, USA.
Weidun Alan GuoDivision of Trauma/Critical Care, Department of Surgery, The State University of New York, Buffalo, NY, USA.
Mark J SeamonDivision of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Penn Presbyterian Medical Center, Philadelphia, PA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionThe relationship between trauma volumes and patient outcomes continues to be controversial, with limited data available regarding the effect of month-to-month trauma volume variability on clinical results. This study examines the relationship between monthly trauma volume variations and patient mortality at seven Level I Trauma Centers located in the Eastern United States. We hypothesized that higher monthly trauma volumes may be associated with lower corresponding mortality.

methodsMonthly patient volume data were collected from seven Level I Trauma Centers. Additional information retrieved included monthly mortality, demographics, mean monthly injury severity (ISS), and trauma mechanism (blunt versus penetrating). Mortality was utilized as the primary study outcome. Statistical corrections for mean age, gender distribution, ISS, and mechanism of injury were made using analysis of co-variance (ANCOVA). Center-specific, annually-adjusted median monthly volumes (CSAA-MMV) were calculated to standardize patient volume differences across participating institutions. Statistical significance was set at α < 0.05.

resultsA total of 604 months of trauma admissions, encompassing 122,197 patients, were analyzed. Controlling for patient age, gender, ISS, and mechanism of injury, aggregate data suggested that monthly trauma volumes < 100 were associated with significantly greater mortality (3.9%) than months with volumes > 400 (mortality 2.9%, p < 0.01). To account for differences in monthly volumes between centers, as well as for temporal bias associated with potential differences over the entire study duration period, data were normalized using CSAA-MMV as a standardized reference point. Monthly volumes ≤ 33% of the CSAA-MMV were associated with adjusted mortality of 5.0% whereas monthly volumes ≥ 134% CSAA-MMV were associated with adjusted mortality of 2.7% (p < 0.01).

conclusionsThis hypothesis-generating study suggests that greater monthly trauma volumes appear to be associated with lower mortality. In addition, our data also suggest that across all participating centers mortality may be a function of relative month-to-month volume variation. When normalized to institution-specific, annually-adjusted "median" monthly trauma contacts, we show that months with patient volumes ≤ 33% median may be associated with subtly but not negligibly (1.4-2.3%) higher mortality than months with patient volumes ≥ 134% median.

Indexed as

Trauma CentersAdultAge DistributionDatabases, FactualFemaleHospitalizationHospital MortalityHumansInjury Severity ScoreLogistic ModelsMaleMiddle AgedSex DistributionUnited StatesWounds and InjuriesCare optimizationMortalityMulti-center studyPopulation studyTrauma networksTrauma outcomesTrauma volumes

Identifiers

PMID29330633

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.