BACKGROUND: The 1999 American College of Surgeons resources for optimal care document added the requirement that Level I trauma centers admit over 240 patients with Injury Severity Score (ISS) > 15 per year or that trauma surgeons care for at least 35 patients per year. The purpose of this study was to test the hypothesis that high volume of patients with ISS > 15 per individual trauma surgeon is associated with improved outcome. METHODS: Data were obtained from the trauma registry of the five American College of Surgeons-verified adult Level I trauma centers in our mature trauma system between January 1, 1998, and March 31, 1999. Data abstracted included age, sex, Glasgow Coma Scale (GCS) score, intensive care unit length of stay, hospital length of stay, probability of survival (Ps), mechanism of injury, number of patients per each trauma surgeon and institution, and mortality. Multiple logistic regression was performed to select independent variables for modeling of survival. RESULTS: From the five Level I centers there were 11,932 trauma patients in this time interval; of these, 1,754 patients (14.7%) with ISS > 15 were identified and used for analysis. Patients with ISS > 15 varied from 173 to 625 per institution; trauma surgeons varied from 8 to 25 per institution; per-surgeon patient volume varied from 0.8 to 96 per year. Logistic regression analysis revealed that the best independent predictors of survival were Ps, GCS score, age, mechanism of injury, and institutional volume (p < 0.01). Age and institutional volume correlated negatively with survival. Analysis of per-surgeon patient caseload added no additional predictive value (p = 0.44). CONCLUSION: The significant independent predictors of survival in severely injured trauma patients are Ps, GCS score, age, mechanism of injury, and institutional volume. We found no statistically meaningful contribution to the prediction of survival on the basis of per-surgeon patient volume. Since this volume criterion for surgeon enpanelment and trauma center designation would not be expected to improve outcome, such a requirement should be justified by other measures or abandoned.
BACKGROUND: The 1999 American College of Surgeons resources for optimal care document added the requirement that Level I trauma centers admit over 240 patients with Injury Severity Score (ISS) > 15 per year or that trauma surgeons care for at least 35 patients per year. The purpose of this study was to test the hypothesis that high volume of patients with ISS > 15 per individual trauma surgeon is associated with improved outcome. METHODS: Data were obtained from the trauma registry of the five American College of Surgeons-verified adult Level I trauma centers in our mature trauma system between January 1, 1998, and March 31, 1999. Data abstracted included age, sex, Glasgow Coma Scale (GCS) score, intensive care unit length of stay, hospital length of stay, probability of survival (Ps), mechanism of injury, number of patients per each trauma surgeon and institution, and mortality. Multiple logistic regression was performed to select independent variables for modeling of survival. RESULTS: From the five Level I centers there were 11,932 traumapatients in this time interval; of these, 1,754 patients (14.7%) with ISS > 15 were identified and used for analysis. Patients with ISS > 15 varied from 173 to 625 per institution; trauma surgeons varied from 8 to 25 per institution; per-surgeon patient volume varied from 0.8 to 96 per year. Logistic regression analysis revealed that the best independent predictors of survival were Ps, GCS score, age, mechanism of injury, and institutional volume (p < 0.01). Age and institutional volume correlated negatively with survival. Analysis of per-surgeon patient caseload added no additional predictive value (p = 0.44). CONCLUSION: The significant independent predictors of survival in severely injured traumapatients are Ps, GCS score, age, mechanism of injury, and institutional volume. We found no statistically meaningful contribution to the prediction of survival on the basis of per-surgeon patient volume. Since this volume criterion for surgeon enpanelment and trauma center designation would not be expected to improve outcome, such a requirement should be justified by other measures or abandoned.
Authors: Hunter B Moore; Ernest E Moore; Clay C Burlew; Walter L Biffl; Fredric M Pieracci; Carlton C Barnett; Denis D Bensard; Gregory J Jurkovich; Charles J Fox; Angela Sauaia Journal: J Am Coll Surg Date: 2016-04-21 Impact factor: 6.113
Authors: Robert D Becher; Michael P DeWane; Nitin Sukumar; Marilyn J Stolar; Thomas M Gill; Adrian A Maung; Kevin M Schuster; Kimberly A Davis Journal: Ann Surg Date: 2019-02-08 Impact factor: 12.969
Authors: K John McConnell; Craig D Newgard; Richard J Mullins; Melanie Arthur; Jerris R Hedges Journal: Health Serv Res Date: 2005-04 Impact factor: 3.402
Authors: M T Zacher; K-G Kanz; M Hanschen; S Häberle; M van Griensven; R Lefering; V Bühren; P Biberthaler; S Huber-Wagner Journal: Br J Surg Date: 2015-07-07 Impact factor: 6.939
Authors: Robert D Becher; Michael P DeWane; Nitin Sukumar; Marilyn J Stolar; Thomas M Gill; Adrian A Maung; Kevin M Schuster; Kimberly A Davis Journal: Ann Surg Date: 2020-08 Impact factor: 13.787
Authors: Charlie A Sewalt; Eveline J A Wiegers; Fiona E Lecky; Dennis den Hartog; Stephanie C E Schuit; Esmee Venema; Hester F Lingsma Journal: Scand J Trauma Resusc Emerg Med Date: 2020-03-06 Impact factor: 2.953