Patients with severe head injuries tend to fare better if they are taken to a specialized trauma center rather than to a hospital without these specialized care capabilities, according to a new study by Perelman School of Medicine researchers at the University of Pennsylvania.
The findings show 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 to a non-trauma center. In addition, head-trauma patients over 65 were significantly less likely to die from their head injury if they went to a trauma center first.
Still, the study found that 44 percent of head trauma patients are taken to non-trauma centers. The results, published in the Journal of the American College of Surgeons, point to a serious care disparity for these patients and highlight the need for systematic changes to improve care.
“These findings highlight a big opportunity to improve outcomes for head injury patients,” said the study’s senior author, M. Kit Delgado, M.D. M.S., 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.”
“It’s good to now have evidence that demonstrates the benefit of traveling farther to a trauma center for these patients. 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.”
For the study, the researchers analyzed data on emergency room visits for six states (New Jersey, North Carolina, Arizona, New York, Florida, and Utah) 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).
The researchers matched trauma-center and non-trauma center patients according to their sociodemographics, geography, cause, type, and severity of injury, and other variables. They then used the patient’s relative distance from their home to the closest trauma center and non-trauma center with neurosurgery as a variable that effectively randomized where patients were treated.
In the resulting matched set of 21,823 cases, the researchers found that 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, while patients 65-and-older had a 3.4 percent lower risk of mortality with equal rates of being favorably discharged.
“These estimates of the benefits of sending patients to a trauma center are probably conservative, since we didn’t include patients sent to non-trauma centers without neurosurgical capabilities,” said lead author Elinore J. Kaufman, M.D., M.S.H.P., a resident in General Surgery at New York-Presbyterian Weill Cornell Medicine, who was a Penn Master of Science in Health Policy Research (MSHP) degree candidate at the time of the study.
She added that the results for the two age groups are consistent with an overall improvement in outcomes. “If some of the older patients survived at trauma centers when they wouldn’t have survived at non-trauma centers, that would have reduced mortality for that group but left many of those survivors in need of ongoing care and rehabilitation.”
Head injuries contribute to 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.