Effect of regional trauma centralization on volume, injury severity and outcomes of injured patients admitted to trauma centres. Issue 8 (10th June 2014)

• Record Type: Journal Article
• Authors: Metcalfe, D; Bouamra, O; Parsons, N R; Aletrari, M-O; Lecky, F E; Costa, M L
• Is Part Of: British journal of surgery. Volume 101:Issue 8(2014:Aug.)
• Page Start: 959
• Page End: 964
• Publication Date: 2014-06-10
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1002/bjs.9498
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Background: Centralization of complex healthcare services into specialist high-volume centres is believed to improve outcomes. For injured patients, few studies have evaluated the centralization of major trauma services. The aim of this study was to evaluate how a regional trauma network affected trends in admissions, case mix, and outcomes of injured patients. Methods: A retrospective before–after study was undertaken of severely injured patients attending four hospitals that became major trauma centres (MTCs) in March 2012. Consecutive patients with major trauma were identified from a national registry and divided into two groups according to injury before or after the launch of a new trauma network. The two cohorts were compared for differences in case mix, demand on hospital resources, and outcomes. Results: Patient volume increased from 442 to 1326 (200 per cent), operations from 349 to 1231 (253 per cent), critical care bed-days from 1100 to 3704 (237 per cent), and total hospital bed-days from 7910 to 22 772 (188 per cent). Patient age increased on MTC designation from 45·0 years before March 2012 to 48·2 years afterwards ( P = 0·021), as did the proportion of penetrating injuries (1·8 versus 4·1 per cent; P = 0·025). Injury severity fell as measured by median Injury Severity Score (16 versus 14) and Revised Trauma Score (4·1 versus 7·8). Fewer patients required secondary transfer to a MTC from peripheral hospitals (19·9 versus 16·1 per cent; P = 0·100). There were no significant differences in total duration of hospital stay, critical care requirements or mortality. However, there was a significant increase, from 55·5 to 62·3 per cent ( P < 0·001), in the proportion of patients coded as having a 'good recovery' at discharge after institution of the trauma network. Conclusion: MTC designation leads to an increased case volume with considerable implications for operating theatre capacity and bed occupancy. Although no mortality benefit was demonstrated within 6 months of establishing this trauma network, early detectable advantages included improved functional outcome at discharge. Abstract : Limited effect of centralization