Effect of trauma center designation on outcome in patients with severe traumatic brain injury.
OBJECTIVE
To determine the association of the American College of Surgeons (ACS) designation with outcomes in patients, specifically those with severe traumatic brain injuries.


METHODS
A retrospective review. Logistic regression was performed for mortality, complications, and progression of initial neurologic insult.


METHODS
Data from the National Trauma Data Bank.


METHODS
A total of 16,037 patients with isolated severe head injury (head acute injury score, > or =3 and other body region abbreviated injury score, <3) classified into 2 groups (level 1 and level 2) according to ACS designation.


RESULTS
Patients admitted to a level 2 center had higher mortality rates (13.9% vs 9.6%; P < .001), higher rates of complication (15.5% vs 10.6%; P < .001), and higher rates of progression of initial neurologic insult (2.0% vs 1.1%; P < .001). After adjustment for the factors that were different between the 2 groups, admission to a level 2 facility remained an independent predictor of mortality (adjusted odds ratio [OR], 1.57; 95% confidence interval [CI], 1.41-1.75; P < .001), complications (adjusted OR, 1.55; 95% CI, 1.40-1.71; P < .001), and progression of neurologic insult (adjusted OR, 1.78; 95% CI, 1.37-2.31; P < .001). Other independent risk factors for mortality were penetrating mechanism, age of 55 years or older, Injury Severity Score of 20 or higher, Glasgow Coma Scale score of 8 or lower, and hypotension (systolic blood pressure, <90 mm Hg).


CONCLUSIONS
Patients with severe traumatic brain injury treated in ACS-designated level 1 trauma centers have better survival rates and outcomes than those treated in ACS-designated level 2 centers.
DuBose
Joseph J
JJ
Los Angeles County Hospital, University of Southern California School of Medicine, Los Angeles, California 90033-4525, USA. jjd3c@yahoo.com
Browder
Timothy
T
Inaba
Kenji
K
Teixeira
Pedro G R
PG
Chan
Linda S
LS
Demetriades
Demetrios
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000401:mortality / Q000628:therapy*; D019992:Databases as Topic; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014193:Trauma Centers / Q000145:classification / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult