Effect of Trauma Center Designation on Outcome in Patients With Severe Traumatic Brain Injury

Objective: To determine the association of the American College of Surgeons ( ACS) designation with outcomes in patients, specifically those with severe traumatic brain injuries. Design: A retrospective review. Logistic regression was performed for mortality, complications, and progression of initial neurologic insult. Setting: Data from the National Trauma Data Bank. Patients: A total of 16 037 patients with isolated severe head injury ( head acute injury score, >= 3 and other body region abbreviated injury score, < 3) classified into 2 groups ( level 1 and level 2) according to ACS designation. Results: Patients admitted to a level 2 center had higher mortality rates ( 13.9% vs 9.6%; P < .001), higher rates of complication ( 15.5% vs 10.6%; P < .001), and higher rates of progression of initial neurologic insult ( 2.0% vs 1.1%; P < .001). After adjustment for the factors that were different between the 2 groups, admission to a level 2 facility remained an independent predictor of mortality ( adjusted odds ratio [ OR], 1.57; 95% confidence interval [ CI], 1.41-1.75; P < .001), complications ( adjusted OR, 1.55; 95% CI, 1.40-1.71; P < .001), and progression of neurologic insult ( adjusted OR, 1.78; 95% CI, 1.37-2.31; P < .001). Other independent risk factors for mortality were penetrating mechanism, age of 55 years or older, Injury Severity Score of 20 or higher, Glasgow Coma Scale score of 8 or lower, and hypotension ( systolic blood pressure, < 90 mm Hg). Conclusion: Patients with severe traumatic brain injury treated in ACS-designated level 1 trauma centers have better survival rates and outcomes than those treated in ACS-designated level 2 centers.