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Head Injury Patients Benefit by Bypassing Other EDs to Get to Trauma Centers

Even though head injury patients do better if they are transported to designated trauma centers, nearly half end up first at emergency departments (EDs) without those specialized care programs.

A study published in the Journal of the American College of Surgeons reports that patients younger than 65 were more likely to be able to go home without the need for inpatient rehabilitation or ongoing nursing care if initially treated at a trauma center. Those 65 or older were less likely to die if they first received specialty care. Yet, according to the report, 44% of head injury patients begin at hospitals without trauma care designations.

“These findings highlight a big opportunity to improve outcomes for head injury patients,” the senior author, M. Kit Delgado, MD, MS, an assistant professor of emergency medicine and epidemiology at Perelman School of Medicine at the University of Pennsylvania, said in a university press release. “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.”

Background information in the article notes that ED and hospital visits for head injuries increased from 521 to 824 per 100,000 people annually between 2000 and 2010. Although previous studies have determined that younger patients have significantly improved outcomes if treated in trauma centers, similar research related to older adults or patients with isolated head injuries is lacking.

The researchers point out that the issue isn’t as clear cut with these cases: Time to treatment often is critical, and non-trauma centers often have neurosurgeons on staff capable of treating isolated head injuries.

To help resolve the question, the study team examined databases on ED visits for six states — New Jersey, North Carolina, Arizona, New York, Florida, and Utah — during 2011 and 2012. Over 62,000 patients were identified with severe, isolated head injuries who had been taken either to a trauma center, 56%, or a non-trauma center capable of performing neurosurgery, 44%.

Randomizing to a matched set of 21,823 cases, the researchers determined that patients transported to trauma centers fared significantly better than those taken to non-trauma centers. Although no mortality benefit was identified for patients younger than 65, they had a 6.9% higher rate of favorable discharge. Meanwhile, older patients had a 3.4% lower risk of dying and even had chances of being favorably discharged.

The researchers note that their estimates are conservative because they didn’t include non-trauma centers without neurosurgical capabilities. They conclude that “patients with isolated, severe head injury have better outcomes if initially treated in designated trauma centers. As 40% of such patients were triaged to non-trauma centers, there are major opportunities for improving outcomes.”

“It's good to now have evidence that demonstrates the benefit of traveling farther to a trauma center for these patients,” Delgado pointed out. “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.”