Decreased Mortality in Traumatic Brain Injury Following Regionalization of Trauma Across Hospital Systems

4/21/2015

Objectives:
The Northern Ohio Trauma System (NOTS) was established to improve outcomes of trauma patients across the region. We hypothesized that mortality in patients with traumatic brain injury (TBI) would improve after regionalization.

Methods:
All patients >14 years with a TBI were identified from NOTS, a regional trauma system consisting of 2 large healthcare systems and regional EMS providers. Data from 2008 through 2012 were analyzed before and after NOTS formation in 2010. Multivariate regression analysis (RA) was performed to evaluate independent predictors of survival.

Results:
11,220 patients were identified with TBI in the NOTS database during the study period; 4507 (40%) before NOTS and 6713 (60%) after NOTS. The percentage of patients presenting to the regional level 1 center post-NOTS increased from 35% to 66% (p<.0001). TBIs in the post-NOTS group were older (median age 55 vs. 52, p= 0.02) and less likely male (p=0.001). Injury severity scores and Abbreviated Injury Scores (AIS) were similar between periods. Post-NOTS TBIs had a lower median ICU stay (p=0.001) and were more likely to present via air transport (p=0.02). The mortality rate decreased from 6.2% to 4.9% (p=0.005) among all TBIs and from 19% to 14% (p<.0001) in TBIs with a Head AIS≥3 (N= 2,570). Craniotomy procedures increased from 1.8% to 2.7% (p= 0.003) in all TBIs and from 5.9% to 8.1% ( p= 0.02) in those with Head AIS≥3. RA demonstrated an independent effect on survival for post-NOTS period. The OR for TBI patients in the post-NOTS period was 1.3 (95% CI: 1.1-1.6; C-stat= 0.96) and in TBI patients with Head AIS≥3 was 1.4 ( 95% CI: 1.1-1.7; C-stat=0.86).

Conclusion:
Regionalization of an urban trauma system is associated with a reduced mortality rate for patients with TBI, particularly for patients with a Head AIS≥3. These findings support regionalization of trauma in a spirit of collaboration across health care systems.