Trauma Patient Volume and the Quality of Care: A Scoping Review

Wouter Foppen; Yvette Claassen; Debby Falck; Nardo J M van der Meer

doi:10.3390/jcm12165317

Trauma Patient Volume and the Quality of Care: A Scoping Review

J Clin Med. 2023 Aug 15;12(16):5317. doi: 10.3390/jcm12165317.

Authors

Wouter Foppen¹, Yvette Claassen², Debby Falck³, Nardo J M van der Meer^{4

5}

Affiliations

¹ Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht University, 3584 CS Utrecht, The Netherlands.
² Department of Surgery, Leids Universitair Medisch Centrum, 2333 ZA Leiden, The Netherlands.
³ Department of Neurology, HagaZiekenhuis, 2545 AA The Hague, The Netherlands.
⁴ Department of Medicine, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands.
⁵ TIAS School for Business and Society, 5037 AB Tilburg, The Netherlands.

Abstract

Background: Healthcare stakeholders in the Netherlands came to an agreement in 2022 to deal with present and future challenges in healthcare. Among others, this agreement contains clear statements regarding the concentration of trauma patients, including the minimal required number of annual severe trauma patients for Major Trauma Centers. This review investigates the effects of trauma patient volumes on several domains of the quality of healthcare.

Methods: PubMed was searched; studies published during the last 10 years reporting quantitative data on trauma patient volume and quality of healthcare were included. Results were summarized and categorized into the quality domains of healthcare.

Results: Seventeen studies were included with a total of 1,517,848 patients. A positive association between trauma patient volume and survival was observed in 11/13 studies with adjusted analyses. Few studies addressed other quality domains: efficiency (n = 5), safety (n = 2), and time aspects of care (n = 4). None covered people-centeredness, equitability, or integrated care.

Conclusions: Most studies showed a better survival of trauma patients when treated in high-volume hospitals compared to lower volume hospitals. However, the ideal threshold could not be determined. The association between trauma volume and other domains of the quality of healthcare remains unclear.

Keywords: mortality; outcome analysis; polytrauma; quality of healthcare; trauma systems.

Publication types

Review

Grants and funding

The authors did not receive support from any organization for the submitted work. Sources of funding in included studies: The studies by Nakahara et al. and Wada et al. were both supported by a Grant for Research on Regional Medical Care from the Ministry of Health, Labour and Welfare, Japan [,18]. The study by Clement et al. was supported by a NIH K08 grant [20]. Statements concerning funding or conflicts of interest were not reported by Miyata et al. [16]. The other studies reported no conflicts of interest or research funding.