Association between adult trauma patient volume in intensive care units and hospital mortality in severely injured trauma patients

Abstract text (incl. references and figure legends)

Introduction To assess an association between adult trauma patient volume in intensive care units (ICU) and hospital mortality in severely injured trauma patients.

Methods A nationwide-registry-based retrospective cohort study utilized data of the Japan Trauma Databank from the year of 2004 to 2018. The study population included trauma patients who aged >15 year old and initially survived to hospitalize in the intensive care unit. An association of the quartile of ICU trauma patients volume and in-hospital mortality was assessed by generalized estimating equation model which was adjusted for individual level covariates consisted of age, gender, the injury severity score, and trauma mechanism and a cluster level covariate as hospital ID. Similary, another analysis estimated a non-linear association between ICU patient volume and in-hospital mortality using a generalized additive mixed effect model adjusting for the same covariates of the generalized estimating equation analysis.

Results Of 338,774 patients registered in the JTDB, 170,844 were eligible as the study participants and were further divided into 4 strata (42,067, 43,861, 41,938, and 42,978 patients) according to the quartile of annual institutional ICU trauma patient volume (0 to 92, 93 to 152, 153 to 211, and 212+ patients / year), respectively. The mean age (57, 56, 57, and 55) and mean injury severity score (19, 18, 17, and 16) of the study participants differed across the quantile, respectively. Crude hospital mortality of the strata showed a decreasing trend which comprised 12.7%, 10.1%, 9.7%, and 7.5%, respectively. The association between trauma patient volume and hospital mortality showed a negative correlation both in the analyses with the volume as quartile and a continuous variable after adjustment for the covariates (Figure).

Conclusion The association of adult trauma patient volume in the Japanese ICU per year and adjusted hospital mortality risk showed a negative correlation.

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