Details

Autor(en) / Beteiligte

• Chalouhi, Nohra
• Saiegh, Fadi Al
• Starke, Robert M
• Jallo, Jack

Titel

178 Comparison of Outcomes in Level I versus Level II Trauma Centers in Patients Undergoing Craniotomy or Craniectomy for Severe Traumatic Brain Injury

Ist Teil von

• Neurosurgery, 2018-09, Vol.65 (CN_suppl_1), p.108-108

Ort / Verlag

Philadelphia: Oxford University Press

Erscheinungsjahr

2018

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• Abstract INTRODUCTION Traumatic brain injury (TBI) still carries a devastatingly high rate of morbidity and mortality. This study is the first to assess whether patients undergoing a craniotomy or craniectomy for severe TBI fare better at level I than level II trauma centers. METHODS The data were extracted from the Pennsylvania Trauma Outcome Study database (the Pennsylvania Trauma Systems Foundation statewide trauma registry), which contains data collected by each of the 31 accredited level I and II trauma centers in the state. Inclusion criteria were patients older than the age of 18 yr with severe TBI (Glasgow Coma Scale [GCS] score of lower than 9) undergoing craniotomy or craniectomy in the state of Pennsylvania between January 2002 and September 2017. RESULTS Of 3980 patients, 2568 (64.5%) were treated at level I trauma centers and 1412 (35.5%) at level II centers. Baseline characteristics were grossly similar between the 2 groups except for significantly worse GCS scores at admission in level I centers (P = .002). The rate of in-hospital mortality was 37.6% in level I trauma centers versus 40.4% in level II trauma centers (P = .08). Likewise, mean FIM scores at discharge were significantly higher in level I (10.9 ± 5.5) than level II centers (9.8 ± 5.3; P < .005). In multivariate analysis, treatment at a level II trauma center significantly predicted in-hospital mortality (odds ratio [OR] 1.2; 95% confidence interval [CI] 1.03-1.37; P = .01) and worse FIM scores (OR 1.4; 95% CI 1.1-1.7; P = .001). Mean hospital and intensive care unit length of stay were significantly longer in level I centers (P < .005). CONCLUSION Even in a mature trauma system, patients undergoing craniotomy or craniectomy for severe TBI have superior functional outcomes and lower mortality rates in level I compared with level II trauma centers. The findings support the rapid transfer of such patients to level I trauma centers.