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The Effect of Trauma Center Verification Level on Outcomes in Traumatic Brain Injury Patients Undergoing Interfacility Transfer
Author(s) -
Plurad David S.,
Geesman Glenn,
Mahmoud Ahmed,
Sheets Nicholas,
ChawlaKondal Bhani,
Ayutyat Napatkamon,
Ghostine Samer,
Guldner Gregory
Publication year - 2021
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.14145
Subject(s) - medicine , trauma center , glasgow coma scale , traumatic brain injury , injury severity score , logistic regression , emergency medicine , revised trauma score , incidence (geometry) , emergency department , poison control , injury prevention , retrospective cohort study , surgery , physics , psychiatry , optics
Background Previous literature demonstrates increased mortality for traumatic brain injury (TBI) with transfer to a Level II versus Level I trauma center. Our objective was to determine the effect of the most recent American College of Surgeons–Committee on Trauma (ACS‐COT) “Resources for the Optimal Care of the Injured Patient” resources manual (“The Orange Book”) on outcomes after severe TBI after interfacility transfer to Level I versus Level II center. Methods Utilizing the Trauma Quality Program Participant Use File of the American College of Surgeons admission year 2017, we identified patients with isolated TBI undergoing interfacility transfer to either Level I or Level II trauma center. Logistic regression was performed to determine independent associations with mortality. Results There were 10,268 (71.6%) transferred to a Level I center and 4,025 (28.4%) were transferred to a Level II center. They were mostly male (61.4%) with a mean ± SD age of 61 ± 20.8 years. Mean Injury Severity Score was 16.3 ± 6.3 and most were injured in a single‐level fall (51.5%). Patients transferred to a Level I center were less likely to be White (82.3% vs. 84.7%, 0.002) and more likely to have sustained penetrating trauma (2.7% vs. 1.6%, <0.001). The incidence of severe TBI (Glasgow Coma Scale [GCS] = 3–8) was similar (9.3% vs. 8.3%, 0.068). On logistic regression, severity of TBI predicted death; however, there was no difference in adjusted mortality outcome with admission to a Level II versus a Level I center (0.998 [0.836–1.192], 0.985). Conclusions There is no mortality discrepancy in patients with isolated TBI transferred to a Level II versus Level I center despite previous contrary evidence and thus no reason to bypass a Level II in favor of a Level I. This relative improvement potentially relates to the new requirements as defined in the latest version of the ACS‐COT’s resources manual.