Head injuries contribute to more than 50,000 deaths annually in the U.S., and traumatic brain injury is a leading cause of long-term disability. Although both trauma centers and non-trauma centers in the United States treat patients with head injuries, it was, until recently, unknown whether initial triage to trauma centers vs non-trauma centers improves outcomes for severe isolated head injury.
A recent publication from the Perelman School of Medicine at the University of Pennsylvania, Comparative Effectiveness of Initial Treatment at Trauma Center vs. Neurosurgery-Capable Non-Trauma Center for Severe, Isolated Head Injury, was the largest study to date on the comparative effectiveness of trauma center vs. non-trauma center care for patients with severe, isolated head injuries sheds light on this issue, and underscores the disparity in care for this population.
Physician researchers M. Kit Delgado, MD (lead author) and Daniel N. Holena, MD of Penn Medicine, Dylan S. Small, PhD of the Wharton School and Leonard Davis Institute of Health Economics, and Ashkan Ertefaie of the University of Rochester contributed to the study.
The study compared in-hospital mortality and discharge status for adults who initially presented to either a trauma center or a neurosurgery-capable non-trauma center for treatment of severe isolated head injury. Using a database from the State Emergency Department and Inpatient Databases (2011 to 2012) for six states, the authors identified 62,198 patients with severe, isolated head injuries who had been taken to either a trauma center (56%) or to a neurosurgery-capable non-trauma center (44%). The patient's relative distance from their home to the closest trauma center and neurosurgery-capable non-trauma center were then used as variables to randomize patients.
Study Results
The researchers found that patients with isolated, severe head injury had better outcomes if initially treated in designated trauma centers. ("As 40% of such patients were triaged to non-trauma centers, there are major opportunities for improving outcomes.") In multivariable matched instrumental variable analysis, initial presentation to a trauma center was associated with no significant difference in overall mortality (1.3%) when compared to a non-trauma center, but a 5.8% higher rate of discharge home rather than to a skilled nursing facility or long-term care.
The study also offered evidence to demonstrate the benefit of traveling farther to a trauma center for patients with severe isolated head injury. Among patients aged 65 years or older, initial presentation to a trauma center was associated with a 3.4% reduction in mortality.
"These findings highlight a big opportunity to improve outcomes for head injury patients," Dr. Delgado told Penn Medicine News. "It's clear that these patients are ending up in regional trauma centers that may not have the protocols, resources and experience to appropriately treat these severe injuries."
Dr. Delgado is a practicing emergency medicine physician at Penn Presbyterian Medical Center (Level 1 Trauma Center) and the Hospital of the University of Pennsylvania. Additionally, Dr. Delgado teaches at the Perelman School of Medicine at the University of Pennsylvania (Assistant Professor of Emergency Medicine; Assistant Professor of Epidemiology in Biostatistics and Epidemiology), and is Senior LDI Fellow at Penn's Leonard Davis Institute of Health Economics.
Penn Presbyterian Medical Center: Level 1 Trauma Center
Penn Presbyterian Medical Center is home to Penn's Level 1 Trauma Center, a key passage for traumatically injured patients with cutting edge technology and resources, and expertly trained clinical teams. Each year, our Level 1 Trauma Center treats thousands with exceptional patient outcomes that rank well above national averages.
Transfers to Penn Presbyterian Medical Center
Penn's Level 1 Trauma Center has one of the highest rates of patient transfers in the region. Referring physicians have 24/7 access to Penn Medicine physicians for emergency transfers, and patient consults via Penn's provider-only line: 877-937-7366.
Penn also provides referring physicians with patient resources for caregivers to share during the transfer process.
Additional Resources from Penn Medicine