학술논문
Association Between Emergency Medical Service Agency Volume and Mortality in Trauma Patients.
Document Type
Academic Journal
Author
Silver DS; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.; Sperry JL; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.; Beiriger J; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.; Lu L; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.; Guyette FX; Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA.; Wisniewski S; Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.; Moore EE; Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO.; Schreiber M; Division of Trauma, Critical Care, & Acute Care Surgery, Oregon Health & Science University, Portland, OR.; Joseph B; Department of Surgery, Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of Arizona, Tucson, AZ.; Wilson CT; Department of Surgery, Baylor College of Medicine, Houston, TX.; Cotton B; Department of Surgery, Division of Acute Care Surgery and Center for Translational Injury Research, McGovern Medical School at the University of Texas Health Science Center, Houston, TX.; Ostermayer D; Department of Emergency Medicine, University of Texas Health Science Center, McGovern Medical School, Houston, TX.; Fox EE; Department of Surgery, Division of Acute Care Surgery and Center for Translational Injury Research, McGovern Medical School at the University of Texas Health Science Center, Houston, TX.; Harbrecht BG; Department of Surgery, University of Louisville, Louisville, KY.; Patel M; Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.; Brown JB; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Source
Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0372354 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1528-1140 (Electronic) Linking ISSN: 00034932 NLM ISO Abbreviation: Ann Surg Subsets: MEDLINE
Subject
Language
English
Abstract
Objective: The aim of this study was to evaluate the association of annual trauma patient volume on outcomes for emergency medical services (EMS) agencies.
Background: Regionalization of trauma care saves lives. The underlying concept driving this is a volume-outcome relationship. EMS are the entry point to the trauma system, yet it is unknown if a volume-outcome relationship exists for EMS.
Methods: A retrospective analysis of prospective cohort including 8 trauma centers and 20 EMS air medical and metropolitan ground transport agencies. Patients 18 to 90 years old with injury severity scores ≥9 transported from the scene were included. Patient and agency-level risk-adjusted regression determined the association between EMS agency trauma patient volume and early mortality.
Results: A total of 33,511 were included with a median EMS agency volume of 374 patients annually (interquartile range: 90-580). Each 50-patient increase in EMS agency volume was associated with 5% decreased odds of 6-hour mortality (adjusted odds ratio=0.95; 95% CI: 0.92-0.99, P =0.03) and 3% decreased odds of 24-hour mortality (adjusted odds ratio=0.97; 95% CI: 0.95-0.99, P =0.04). Prespecified subgroup analysis showed EMS agency volume was associated with reduced odds of mortality for patients with prehospital shock, requiring prehospital airway placement, undergoing air medical transport, and those with traumatic brain injury. Agency-level analysis demonstrated that high-volume (>374 patients/year) EMS agencies had a significantly lower risk-standardized 6-hour mortality rate than low-volume (<374 patients/year) EMS agencies (1.9% vs 4.8%, P <0.01).
Conclusions: A higher volume of trauma patients transported at the EMS agency level is associated with improved early mortality. Further investigation of this volume-outcome relationship is necessary to leverage quality improvement, benchmarking, and educational initiatives.
Competing Interests: The authors report no conflicts of interest.
(Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Background: Regionalization of trauma care saves lives. The underlying concept driving this is a volume-outcome relationship. EMS are the entry point to the trauma system, yet it is unknown if a volume-outcome relationship exists for EMS.
Methods: A retrospective analysis of prospective cohort including 8 trauma centers and 20 EMS air medical and metropolitan ground transport agencies. Patients 18 to 90 years old with injury severity scores ≥9 transported from the scene were included. Patient and agency-level risk-adjusted regression determined the association between EMS agency trauma patient volume and early mortality.
Results: A total of 33,511 were included with a median EMS agency volume of 374 patients annually (interquartile range: 90-580). Each 50-patient increase in EMS agency volume was associated with 5% decreased odds of 6-hour mortality (adjusted odds ratio=0.95; 95% CI: 0.92-0.99, P =0.03) and 3% decreased odds of 24-hour mortality (adjusted odds ratio=0.97; 95% CI: 0.95-0.99, P =0.04). Prespecified subgroup analysis showed EMS agency volume was associated with reduced odds of mortality for patients with prehospital shock, requiring prehospital airway placement, undergoing air medical transport, and those with traumatic brain injury. Agency-level analysis demonstrated that high-volume (>374 patients/year) EMS agencies had a significantly lower risk-standardized 6-hour mortality rate than low-volume (<374 patients/year) EMS agencies (1.9% vs 4.8%, P <0.01).
Conclusions: A higher volume of trauma patients transported at the EMS agency level is associated with improved early mortality. Further investigation of this volume-outcome relationship is necessary to leverage quality improvement, benchmarking, and educational initiatives.
Competing Interests: The authors report no conflicts of interest.
(Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)