K. Prabhakaran1, P. Petrone1, G. Lombardo1, C. Stoller1, A. Betancourt1, A. Policastro1, C. P. Marini1 1Westchester Medical Center University Hospital,Trauma/Surgery/New York Medical College,Valhalla, NY, USA
Introduction: Direct transport of patients with severe traumatic brain injury (STBI) to trauma centers (TCs) that can provide definitive care results in lower mortality rates. Secondary transfers are required when patients with STBI are originally transported to non-trauma centers (NTCs) lacking in neurosurgical expertise, and thus resulting in delay of care. This study investigated the impact of direct versus non-direct transfers on the mortality rates of patients with STBI.
Methods: Data on patients with TBI admitted between 1/1/2012 to 12/31/2013 to our Level I TC were obtained from the trauma registry. Data included patient age, sex, mechanism and type of injury, co-morbidities, Glasgow Coma Scale (GCS), Injury Severity scores, pre-hospital time (PHT), time to request and to transfer, time to initiation of multimodality monitoring and goal-directed therapy protocol (MM&GDTP), dwell time in the emergency department (EDT), and mortality. Data, reported in means ± SD, were analyzed with the student t-test and chi-square. Statistical significance was accepted at a p value < 0.05.
Results:
STBI Direct transfer to TC vs. transfer from NTC: Of the 1,187 patients with TBI admitted to our TC, 768 (64.7%) were directly from the scene while 419 (35.3%) were after secondary transfer. 171 (22.2%) of the direct transfers had GCS < 8 (STBI) and 92 (21.9%) of the secondary transfers had STBI.
Transfer time: Time from scene to arrival to the ED was significantly shorter for TC vs. NTCs 43 ± 14 vs. 77 ± 26 minutes, respectively (p < 0.05). ED dwell time before transfer and time from injury to arrival to TC were 4.2 ± 2.1 and 6.2 ± 8.3 hr, respectively.
MM&GDTP: Time to initiation of MM&GDTP including craniotomy for patients with STBI was 3.1 ± 1.2 vs. 12.4 ± 2.2 hr, for patients arriving from scene to TC as opposed to patients transferred from NTC (p<0.05).
Mortality: There was a statistically significant lower mortality for patients with STBI transferred directly from the scene to TCs as opposed to patients transferred from NTCs, 33/171 (19.3%) vs. 28/92 (30.4%), respectively (p<0.05).
Conclusion: To decrease TBI-related mortality, patients with suspected STBI should be taken directly to a Level I or II TC unless they require life-saving stabilization at NTCs.