Level 1 versus level 2 trauma centers in the treatment of traumatic brain injury
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OBJECTIVE: Evaluate three phases of traumatic brain injury care between Level 1 and Level 2 trauma centers using The Trauma Quality Improvement Program (TQIP). Use Emergency Medical Services (EMS) evaluations to determine which trauma centers, and procedures are preferentially chosen. Use trauma center level and other hospital metrics to distinguish differences between the courses of treatment and outcomes for traumatic brain injury patients (TBI). Evaluate specific neurosurgical procedures and their outcomes were based on the severity of the injury, length of time to procedure, and which trauma centers treated them. DESIGN: Demographic and trauma center readiness were evaluated using Chi Squared analysis .Independent samples T-test and Mann-Whitney U were used to compare variables such as EMS response time, Glasgow Coma Scale (GCS) , Injury Severity Score (ISS), length of stay. Multinomial logistic regression was used to evaluate specific procedures and outcomes. RESULTS: There were significant differences in gender, race, the number of adult beds, the number of beds in the burn unit, the number of beds in the Intensive Care Unit (ICU) for burn recovery, number of beds available in the ICU for trauma recovery, the number of neurosurgeons available, the number of orthopedic surgeons available, and the number of trauma surgeons available between the trauma centers. Also average total GCS, and component GCS metrics were significantly lower in level 1 than level 2 trauma centers. ISS scores based on Abbreviated Injury Scale (AIS) also showed significantly higher ISS scores for Level 1 centers. Patients admitted to Level 1 trauma centers spent significantly longer with EMS responders than Level 2 centers. Level 1 trauma centers have significantly longer average stays for both single head trauma and multiple head trauma patients respectively. The American College of Surgeons (ACS) level of treatment could be predicted by EMS time and GCS. ISS can significantly predict the length of stay in both level 1 and level 2 centers. When controlled for injury severity there was no significant differences in EMS length of response, length of Emergency Department (ED) stay or total length of stay. Types of procedures conducted can be predicted using ACS level, ISS, and EMS response time. There was no significant difference in the lengths of times to procedures, and the outcomes of such procedures could not be predicted. CONCLUSION: TQIP gives us standardized benchmarking to accurately analyze data across different Level 1 and Level 2 trauma centers. The goal is to characterize the course of treatment for TBI patients and improve quality of care. This study showed us that more severe injuries are preferentially treated at higher level trauma centers with longer transit and hospital stays. However, it also it showed us that for very severe injuries the quality of care, and length of time to surgical intervention is consistent across ACS levels.