Medical Student Case Western Reserve University School of Medicine Cleveland, Ohio, United States
Introduction: County-level differences in traumatic brain injury (TBI) outcomes within a regional trauma system are unclear. We examined regional differences in TBI mechanism, outcomes, and risk factors for mortality within five counties, ranging from urban to rural, that are part of a regional trauma system.
Methods: A single-center retrospective review of adult TBI patients admitted to our Level-1 trauma center between 2008 and 2012 revealed 18,769 patients who met inclusion criteria. Demographics, county of residence, TBI characteristics, and outcomes including mortality, craniotomy rates, and transfer to another hospital were collected. Univariate analyses were performed to evaluate differences in patient characteristics and outcomes for all TBI and severe TBI, defined as head abbreviated injury scale (AIS) score ≥ 3, based on county of residence. Multivariate analyses were conducted to assess predictors of mortality across all TBI and severe TBI.
Results: Across all TBI, those living in an urban county were more likely to be African American, with penetrating TBI, while those from rural/suburban counties were more likely to sustain TBI through falling and motor vehicle accidents. Living in a rural/suburban county was associated with higher rates of transfer to other regional trauma center hospitals, less use of ground transport, and higher craniotomy rates. Across severe TBI (odds ratio [confidence interval]), one year increase in age (1.03[1.03-1.04], p< 0.001), sustaining a penetrating injury (3.01[1.83-4.96], p< 0.001), and increased GCS (0.75[0.73-0.77], p< 0.001) were associated with mortality. Being from a rural county was associated with lower odds of mortality across all TBI (0.33[0.13-0.83], p=0.02) as well as severe TBI (0.36[0.14-0.92], p=0.018).
Conclusion : We described county-level differences in TBI patient characteristics, mechanism of injury, and outcomes across a regionalized trauma system. We found that being from a rural county was predictive of lower mortality and associated with higher craniotomy rates, hospital transfer, and shorter hospital transport time.
