title: Neuro, trauma, or med/surg intensive care unit: Does it matter where multiple injuries patients with traumatic brain injury are admitted? Secondary analysis of the American Association for the Surgery of Trauma Multi-Institutional Trials Committee decompressive craniectomy study.
abstract: Patients with nontraumatic acute intracranial pathology benefit from neurointensivist care. Similarly, trauma patients with and without traumatic brain injury (TBI) fare better when treated by a dedicated trauma team. No study has yet evaluated the role of specialized neurocritical (NICU) and trauma intensive care units (TICU) in the management of TBI patients, and it remains unclear which TBI patients are best served in NICU, TICU, or general (Med/Surg) ICU.
  
  
  
  This study is a secondary analysis of The American Association for the Surgery of Trauma Multi-Institutional Trials Committee (AAST-MITC) decompressive craniectomy study. Twelve Level 1 trauma centers provided clinical data and head computed tomography (CT) scans of patients with Glasgow Coma Scale score of 13 or less and CT evidence of TBI. Non-ICU admissions were excluded. Multivariate logistic regression was performed to measure the association between ICU type and survival and calculate the probability of death for increasing Injury Severity Score (ISS). Multiple injuries patients (ISS > 15) with TBI and isolated TBI patients (other Abbreviated Injury Scale score < 3) were analyzed separately.
  
  
  
  There were 3641 patients with CT evidence of TBI with 2951 admitted to an ICU. Before adjustment, patient demographics, injury severity, and survival differed significantly by unit type. After adjustment, unit type, age, and ISS remained independent predictors of death. Unit type modified the effect of ISS on mortality. TBI multiple injuries patients admitted to a TICU had improved survival across increasing ISS. Survival for isolated TBI patients was similar between TICU and NICU. Med/surg ICU carried the greatest probability of death.
  
  
  
  Multiple injuries patients with TBI have lower mortality risk when admitted to a trauma ICU. This survival benefit increases with increasing injury severity. Isolated TBI patients have similar mortality risk when admitted to a neuro ICU compared with a trauma ICU. Med/surg ICU admission carries the highest mortality risk.
  
  
  
  Therapeutic study, level IV.
authors.affiliation: Department of Surgery (S.L.), University of Utah, Salt Lake City, Utah; Baltimore Shock Trauma, (T.S.) University of Maryland, Baltimore, Maryland; Department of Surgery, Division of Trauma and General Surgery (J.S.) University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Surgery, Division of Trauma, Surgical Critical Care, Burns, and Acute Cares Surgery (R.C.), University of California, San Diego, California; Department of Surgery (G.V.), The University of Arizona Medical Center, Tucson, Arizona; Department of Surgery (T.E.), University of Utah, Salt Lake City, Utah; Department of Surgery (G.J.J.), UC Davis Health System, Sacramento, California; and Department of Surgery (R.N.), University of Utah, Salt Lake City, Utah.
authors.forename: Sarah
authors.initials: S
authors.lastname: Lombardo
authors.forename: Thomas
authors.initials: T
authors.lastname: Scalea
authors.forename: Jason
authors.initials: J
authors.lastname: Sperry
authors.forename: Raul
authors.initials: R
authors.lastname: Coimbra
authors.forename: Gary
authors.initials: G
authors.lastname: Vercruysse
authors.forename: Toby
authors.initials: T
authors.lastname: Enniss
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Jurkovich
authors.forename: Raminder
authors.initials: R
authors.lastname: Nirula
mesh_terms: D015998:Abbreviated Injury Scale; D000293:Adolescent; D000328:Adult; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000401:mortality / Q000601:surgery*; D056424:Decompressive Craniectomy; D005260:Female; D006760:Hospitalization; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality / Q000628:therapy*; D014193:Trauma Centers / Q000458:organization & administration*; D014481:United States