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2008 Annual Meeting Abstracts

Outcomes Followings Severe Head Injury: An NTDB Based Comparison of Level I and Level II Trauma Centers
Fuad Alkhoury, MD, John Courtney, MPH, Charles Bakhos , MD, Judy O’Connor, RN, Donald Kim, MD, MBA, John Bonadies, MD, FACS.
Hospital of Saint Raphael, New Haven, CT, USA.

The objective of this study is to analyze the impact of the level of trauma center designation on the outcome of the severely head injured patient.
Retrospective review of longitudinal data
National Trauma Data Bank
The data set of the National Trauma Data Bank between (2001-2006) (NTDB 6.2, American College of Surgeons, Chicago, IL) was queried for all patients with isolated traumatic head injury and Glascow Coma Score (GCS) < 9.
Main Outcome Measures:
Comparisons between Level I and Level II trauma centers were made reviewing hospital length of stay (LOS), ICU LOS, ventilator days, major complication rate (pulmonary embolism, pneumonia, lower extremity DVT) and outcomes of mortality and discharge status. Chi-Square and student t tests were employed to determine statistical significance defined as p <0.05.
The main results are summarized in the following Table.
Level ILevel IIP value
Number of patients227488988Na
Average age34.535.5p<0.0001
Male to female ratio3 to 13 to 1Na
Average ED GCS3.953.98p=0.1038
Average probability of survival0.50.49p=0.4741
Average hospital LOS12.5 d10.77 dp<0.0001
Average ICU LOS7.36 d6.66 dp<0.0001
Average ventilator days6.72 d5.37 dp<0.0001
Incidence of pneumonia11%11%p=0.2240
Incidence of PE0.4 %0.4 %p=0.9799
Incidence of lower extremity DVT1.5 %1.1 %p<0.0001
Discharged home52%50%p=0.017

Level II trauma centers around the country manage isolated complex head injury patients less often but with outcomes and complication rates comparable to that of Level I centers. The transport of head injured patients should not bypass Level II in favor of Level I trauma centers.


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