title: Effect of trauma center designation on outcome in patients with severe traumatic brain injury.
abstract: 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.
authors.affiliation: Los Angeles County Hospital, University of Southern California School of Medicine, Los Angeles, California 90033-4525, USA. jjd3c@yahoo.com
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: DuBose
authors.forename: Timothy
authors.initials: T
authors.lastname: Browder
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Pedro G R
authors.initials: PG
authors.lastname: Teixeira
authors.forename: Linda S
authors.initials: LS
authors.lastname: Chan
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: 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