Confronted with a severe head injury, your first impulse might be to head for the nearest hospital. But a University of Pennsylvania study finds that a designated trauma center would be a better choice in many cases. That’s because trauma centers have specialized capabilities not found at other hospitals.
“These findings highlight a big opportunity to improve outcomes for head injury patients,” said the study’s senior author, M. Kit Delgado, MD MS, an assistant professor of Emergency Medicine and Epidemiology. “Regional trauma centers were set up to serve patients like these, but clearly many of them are still ending up in hospitals that may not have protocols, resources, and experience to appropriately treat these severe injuries.”
Delgado was referring to the study’s finding that 44 percent of severe head injury patients are first taken to hospitals that are not trauma centers, a finding that indicates what the authors called “a serious care disparity.”
The study, said to be the largest of its kind, found that patients under 65 were significantly more likely to fare well — going home from the hospital without the need for nursing care or inpatient rehabilitation — if taken to a trauma center first, rather than a non-trauma center. Patients over 65 were significantly less likely to die from their head injury when they went first to a trauma center.
The results were published today in the Journal of the American College of Surgeons.
Major cause of injuries
Head injuries are a factor in about 50,000 deaths in the United States every year, and the incidence of these injuries appears to be rising. Between 2000 and 2010, emergency room visits and hospitalizations for head injuries increased from 521 to 824 per 100,000 people annually. Head injuries are also a major cause of hospitalization for the elderly, and also account for the majority of severe injuries undertriaged to non-trauma centers.
Prior research has demonstrated that patients under 55 have significantly improved outcomes if treated in trauma centers, but these studies did not determine if older adults or patients with isolated head injuries had the same benefits. Since time to treatment may be critical and many non-trauma centers have neurosurgeons on staff capable of treating isolated head injuries, bypassing these hospitals to travel to further away trauma centers could theoretically lead to unintended consequences.
Delgado and colleagues examined databases on emergency room visits for six states during 2011-12. They identified 62,198 patients with severe, isolated head injuries who had been taken either to a trauma center (56 percent) or to a non-trauma center capable of performing neurosurgery (44 percent).
In matched sets of 21,823 cases, patients taken to trauma centers fared significantly better than those taken to non-trauma centers. Patients under 65 years old saw no mortality benefit, but had a 6.9 percent higher rate of a favorable discharge. Patients 65-and-older had a 3.4 percent lower risk of mortality with equal rates of being favorably discharged.
“It’s good to now have evidence that demonstrates the benefit of traveling farther to a trauma center for these patients,” Delgado said. “Hopefully, this will motivate EMS and trauma systems to double their efforts to triage patients with severe head injuries directly to trauma centers. There is major opportunity to improve outcomes as nearly half of these patients are being taken to non-trauma centers where their outcomes are worse.”