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DOI：10.1097/SLA.0000000000006413.png)
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Objective:This study aims to examine the relationship between procedural volume and annual trauma volume (ATV) of ACS Level I trauma centers (TC).Background:Although ATV is a hard criterion for TC verification, importance of procedural interventions as a potential quality indicator is understudied.Methods:Patients managed at ACS level I TCs were identified from ACS-TQIP 2017-2021. TCs were identified using facility keys and stratified into quartiles based on ATV into low, low-medium, medium-high, and high volume. TCs were also stratified into tertiles [low (LV), medium (MV), high (HV)] based on procedural volume by assessing annual number of laparotomies, thoracotomies, craniotomies/craniectomies, angioembolizations, vascular repairs, and long bone fixations performed at each center. The Cohen kappa statistic was used to assess concordance between ATV and procedural volume.Results:A total of 182 Level I TCs were identified: 76 low, 47 low-medium, 35 high-medium, and 24 high volume. Long bone fixation, laparotomy, and craniotomy/craniectomy were the most performed procedures with a median of 65, 59, and 46 cases/center/year, respectively. Overall, 31% of HV laparotomy centers, 31% of HV thoracotomy centers, 22% of HV craniotomy/craniectomy centers, 22% of HV vascular repair centers, 32% of HV long bone fixation centers, and 33% of HV angioembolization centers contributed to the overall number of low-medium and low-volume TCs. The Cohen kappa statistic demonstrated poor concordance between ATV and procedural volumes for all procedures (overall procedural volume-kappa=0.378, laparotomy-kappa=0.270, thoracotomy-kappa=0.202, craniotomy/craniectomy-kappa=0.394, vascular repair-kappa=0.298, long bone fixation-kappa=0.277, angioembolization-kappa=0.286).Conclusions:ATV does not reflect the procedural interventions performed. Combination of procedural and ATV may provide a more accurate picture of the clinical experience at any given TC.Level of Evidence:Level III.
Keyword:
ACS
procedures
trauma center
verification
volume
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6.4
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5.5W
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