title: Trauma center designation correlates with functional independence after severe but not moderate traumatic brain injury.
abstract: BACKGROUND
  The mortality of traumatic brain injury (TBI) continues to decline, emphasizing functional outcomes. Trauma center designation has been linked to survival after TBI, but the impact on functional outcomes is unclear. The objective was to determine whether trauma center designation influenced functional outcomes after moderate and severe TBI.
  
  
  METHODS
  Trauma subjects presenting to an American College of Surgeons (ACS) Level I or II trauma center with a Glasgow Coma Score (GCS) <or=12 who survived to discharge were identified using the National Trauma Databank (2002-2006). Outcomes were functional independence (FI) defined as a modified functional independence measure (FIM) of 12, and independent expression (IE) defined as a FIM component of 4. These were compared between Level I and Level II centers in subjects with both moderate (GCS 9-12) and severe (GCS <or=8) TBI using stepwise logistic regression to adjust for demographics, injuries, and comorbidities.
  
  
  RESULTS
  Analysis identified 25,170 subjects (72% severe TBI). After adjusting for covariates, ACS Level I designation was associated with FI (odds ratio: 1.16; confidence interval: 1.07-1.24, p < 0.01) and IE (1.10; 1.03-1.17, p < 0.01) after severe TBI. Trauma center designation was not associated with FI or IE after moderate TBI.
  
  
  CONCLUSIONS
  ACS trauma center designation is significantly associated with FI and IE after severe, but not moderate TBI. Prospective study is warranted to verify and explore factors contributing to this discrepancy.
authors.affiliation: Department of Surgery, University of Rochester School of Medicine, Rochester, New York 14642-8410, USA. mark_gestring@urmc.rochester.edu
authors.forename: Joshua B
authors.initials: JB
authors.lastname: Brown
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Stassen
authors.forename: Julius D
authors.initials: JD
authors.lastname: Cheng
authors.forename: Ayodele T
authors.initials: AT
authors.lastname: Sangosanya
authors.forename: Paul E
authors.initials: PE
authors.lastname: Bankey
authors.forename: Mark L
authors.initials: ML
authors.lastname: Gestring
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001930:Brain Injuries / Q000175:diagnosis / Q000401:mortality* / Q000534:rehabilitation*; D003266:Continuity of Patient Care / Q000592:standards* / Q000639:trends; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000592:standards / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D020127:Recovery of Function; D018570:Risk Assessment; D015996:Survival Rate; D014193:Trauma Centers / Q000706:statistics & numerical data*; D016896:Treatment Outcome