title: Decreased intracranial pressure monitor use at level II trauma centers is associated with increased mortality.
abstract: Previous investigations suggest outcome differences at Level I and Level II trauma centers. We examined use of intracranial pressure (ICP) monitors at Level I and Level II trauma centers after traumatic brain injury (TBI) and its effect on mortality. The 2007 to 2008 National Trauma Databank was reviewed for patients with an indication for ICP monitoring based on Brain Trauma Foundation (BTF) guidelines. Demographic and clinical outcomes at Level I and Level II centers were compared by regression modeling. Overall, 15,921 patients met inclusion criteria; 11,017 were admitted to a Level I and 4,904 to a Level II trauma center. Patients with TBI admitted to a Level II trauma center had a lower rate of Injury Severity Score greater than 16 (80 vs 82%, P<0.01) and lower frequency of head Abbreviated Injury Score greater than 3 (80 vs 82%, P<0.01). After regression modeling, patients with TBI admitted to a Level II trauma center were 31 per cent less likely to receive an ICP monitor (adjusted odds ratio [AOR], 0.69; P<0.01) and had a significantly higher mortality (AOR, 1.12; P<0.01). Admission to a Level II trauma center after severe TBI is associated with a decreased use of ICP monitoring in patients who meet BTF criteria as well as an increased mortality. These differences should be validated prospectively to narrow these discrepancies in care and outcomes between Level I and Level II centers.
authors.affiliation: Division of Acute Care Surgery, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
authors.forename: Galinos
authors.initials: G
authors.lastname: Barmparas
authors.forename: Matthew
authors.initials: M
authors.lastname: Singer
authors.forename: Eric
authors.initials: E
authors.lastname: Ley
authors.forename: Rex
authors.initials: R
authors.lastname: Chung
authors.forename: Darren
authors.initials: D
authors.lastname: Malinoski
authors.forename: Daniel
authors.initials: D
authors.lastname: Margulies
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.forename: Marko
authors.initials: M
authors.lastname: Bukur
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014193:Trauma Centers / Q000145:classification