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2008 Annual Meeting Abstracts
Outcomes Followings Severe Head Injury: An NTDB Based Comparison of Level I and Level II Trauma Centers
Fuad Alkhoury, MD, John Courtney, MPH, Charles Bakhos , MD, Judy O’Connor, RN, Donald Kim, MD, MBA, John Bonadies, MD, FACS.
Hospital of Saint Raphael, New Haven, CT, USA.
Objective:
The objective of this study is to analyze the impact of the level of trauma center designation on the outcome of the severely head injured patient.
Design:
Retrospective review of longitudinal data
Setting:
National Trauma Data Bank
Patients:
The data set of the National Trauma Data Bank between (2001-2006) (NTDB 6.2, American College of Surgeons, Chicago, IL) was queried for all patients with isolated traumatic head injury and Glascow Coma Score (GCS) < 9.
Main Outcome Measures:
Comparisons between Level I and Level II trauma centers were made reviewing hospital length of stay (LOS), ICU LOS, ventilator days, major complication rate (pulmonary embolism, pneumonia, lower extremity DVT) and outcomes of mortality and discharge status. Chi-Square and student t tests were employed to determine statistical significance defined as p <0.05.
Results:
The main results are summarized in the following Table. | | | | | Level I | Level II | P value | | Number of patients | 22748 | 8988 | Na | | Average age | 34.5 | 35.5 | p<0.0001 | | Male to female ratio | 3 to 1 | 3 to 1 | Na | | Average ED GCS | 3.95 | 3.98 | p=0.1038 | | Average probability of survival | 0.5 | 0.49 | p=0.4741 | | Average hospital LOS | 12.5 d | 10.77 d | p<0.0001 | | Average ICU LOS | 7.36 d | 6.66 d | p<0.0001 | | Average ventilator days | 6.72 d | 5.37 d | p<0.0001 | | Incidence of pneumonia | 11% | 11% | p=0.2240 | | Incidence of PE | 0.4 % | 0.4 % | p=0.9799 | | Incidence of lower extremity DVT | 1.5 % | 1.1 % | p<0.0001 | | Mortality | 37.7% | 38% | p=0.5983 | | Discharged home | 52% | 50% | p=0.017 |
Conclusions:Level II trauma centers around the country manage isolated complex head injury patients less often but with outcomes and complication rates comparable to that of Level I centers. The transport of head injured patients should not bypass Level II in favor of Level I trauma centers.
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