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Citation
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Dubose JJ, Browder T, Inaba K, Teixeira PG, Chan LS, Demetriades D. Arch. Surg. (1960) 2008; 143(12): 1213-7; discussion 1217. |
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Affiliation
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Los Angeles County Hospital, University of Southern California School of Medicine, Los Angeles, California 90033-4525, USA. jjd3c@yahoo.com |
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Abstract
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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, > or =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.
Language: en |