Document Type
Article
Publication Date
1-1-2020
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.
Recommended Citation
Chalouhi, Nohra; Mouchtouris, Nikolaos; Saiegh, Fadi Al; Starke, Robert M; Theofanis, Thana; Das, Somnath; and Jallo, Jack, "Comparison of Outcomes in Level I vs Level II Trauma Centers in Patients Undergoing Craniotomy or Craniectomy for Severe Traumatic Brain Injury." (2020). Department of Neurosurgery Faculty Papers. Paper 115.
https://jdc.jefferson.edu/neurosurgeryfp/115
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
PubMed ID
30690608
Language
English
Comments
This article has been peer-reviewed. It is the author's final published version in Neurosurgery. Volume 86, Issue 1, January 2020, Pages 107-111.
The published version is available at http://doi.org/10.1093/neuros/nyy634 . Copyright © Chalouhi et.al.