Medical Student UC Davis School of Medicine Sacramento, CA, US
Introduction: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. TBI patients are candidates for early transfer to Level I and II trauma centers. However, there is variability in outside hospital protocols for transferring patients to higher trauma centers. We hypothesized that TBI patients transferred from outside facilities would have worse outcomes than patients presenting directly to a Level I trauma center due to delay in care and possible demographic factors.
Methods: Adult patients, ≥18 years of age, entered into the UC Davis TBI Registry between 2008 and 2021 were studied. Numeric variables were analyzed using Wilcoxon rank sum test and categorical variables were analyzed using chi-square test or Fisher's exact test. Logistic regression models were fit to assess group differences in 6-month outcomes controlling for disease severity. Unfavorable outcomes were defined as modified Rankin score of 0-2.
Results: 5402 patients were included. Directly admitted patients presented to the hospital with more cases of hypotension (p < 0.001), higher intubation rates (p < 0.001) and lower GCS scores (p < 0.001), compared to transfer patients. However, there was no difference in survival at discharge (p= 0.853) or the number of days spent in ICU (p=0.381) between the two groups. When controlling for age and Rotterdam score, the odds of unfavorable outcome or mortality did not significantly differ between directly admitted and transfer patients, p=0.698 and p=0.475, respectively. Transfer patients were significantly older (p < 0.001) with median age of 63 compared to a median age of 52 of directly admitted patients.
Conclusion : Transfer patients had less severe injuries and were older when compared to directly admitted patients. Patients with more severe injuries at lower-tier trauma centers may warrant transfer to Level I trauma centers as 6-month disability outcomes did not differ between transfers and non-transfers.
