People with severe head injuries fare better when treated by trauma centers, even if that means bypassing other hospitals, this research team showed—which presents a major opportunity to improve outcomes for almost half of these patients.
The team, led by Elinore J. Kaufman, MD, MSHP (a Penn Master of Science in Health Policy Research degree candidate at the time of the study), found that patients under 65 were significantly more likely to go home from the hospital without the need for nursing care or inpatient rehabilitation if taken to a trauma center first. Patients over 65 were significantly less likely to die from their head injury when they went to a trauma center first. The results highlight a serious care disparity for these severely injured patients, and point to 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, MD MS. “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,” Delgado added. “Hopefully, this will motivate EMS and trauma systems to double their efforts to triage patients with severe head injuries directly to trauma centers.
The study examined databases on emergency room visits for six states (NJ, NC, AZ, NY, FL, UT) during 2011-12. It 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). While a randomized clinical trial wasn't possible for logistical and ethical reasons, the researchers had enough data to partly simulate a clinical trial setup by matching trauma-center and non-trauma center patients according to socio-demographics; 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 closest non-trauma center with neurosurgery as a variable that effectively randomized where patients were treated.
The researchers say that compliance with current ambulance triage guidelines should be increased. And they suggest future research to inform whether these guidelines need to be revised so that they pick up severe head injuries that may be less obvious at the time of presentation. Improvements in care at non-trauma centers would also reduce the differences in outcomes, Delgado said.