Comparison of Outcomes in Level I vs Level II Trauma Centers in Patients Undergoing Craniotomy or Craniectomy for Severe Traumatic Brain Injury. Issue 1 (24th January 2019)

• Record Type: Journal Article
• Authors: Chalouhi, Nohra; Mouchtouris, Nikolaos; Saiegh, Fadi Al; Starke, Robert M; Theofanis, Thana; Das, Somnath O; Jallo, Jack
• Is Part Of: Neurosurgery. Volume 86:Issue 1(2020)
• Page Start: 107
• Page End: 111
• Publication Date: 2019-01-24
• Subjects: Craniectomy -- Craniotomy -- Traumatic brain injury -- Trauma centers; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyy634
• Languages: English
• ISSNs: 0148-396X

Abstract

ABSTRACT: BACKGROUND: Traumatic brain injury (TBI) carries a devastatingly high rate of morbidity and mortality. OBJECTIVE: To assess whether patients undergoing craniotomy/craniectomy for severe TBI fare better at level I than level II trauma centers in a mature trauma system. METHODS: The data were extracted from the Pennsylvania Trauma Outcome Study database. Inclusion criteria were patients > 18 yr with severe TBI (Glasgow Coma Scale [GCS] score less than 9) undergoing craniotomy or craniectomy in the state of Pennsylvania from January 1, 2002 through September 30, 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 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 centers vs 40.4% in level II centers ( P = .08). Mean Functional Independence Measure (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 level II trauma centers was significantly associated with in-hospital mortality (odds ratio, 1.2; 95% confidence interval, 1.03-1.37; P = .01) and worse FIM scores (odds ratio, 1.4; 95% confidence interval, 1.1-1.7; P = .001). Mean hospital and ICU length of stay were significantly longer in level I centers ( P < .005). CONCLUSION: This study showed superior functional outcomes and lower mortality rates in patients undergoing a neurosurgical procedure for severe TBI in level I trauma centers.