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Joseph J. DuBose, MD; Timothy Browder, MD; Kenji Inaba, MD; Pedro G. R. Teixeira, MD; Linda S. Chan, PhD; Demetrios Demetriades, MD, PhD

Arch Surg. 2008;143(12):1213-1217.

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, 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.

Author Affiliations: Los Angeles County Hospital, University of Southern California School of Medicine, Los Angeles, California.

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Effect of Trauma Center Designation on Outcome in Patients With Severe Traumatic Brain Injury—Invited Critique
David B. Hoyt
Arch Surg. 2008;143(12):1217.
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