ArticleJournal of the American College of Surgeons2018
Comparative Effectiveness of Initial Treatment at Trauma Center vs Neurosurgery-Capable Non-Trauma Center for Severe, Isolated Head Injury.
Article in Journal of the American College of Surgeons, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Transport and destination hospital for patients with suspected multiple and/or severe injuries - a systematic review and clinical practice guideline update.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Pooled it
- Trial
- Geography of the Underserved: The Contribution of Rural Non-trauma Hospitals to Trauma Care.Annals of surgery · 2025Article
- Improving care and equity in the American trauma system: past, present and future.Trauma surgery & acute care open · 2025Article
- Comparison of Outcomes at Trauma Centers versus Non-Trauma Centers for Severe Traumatic Brain Injury.Journal of Korean Neurosurgical Society · 2023Article
- Treatment effects of monosialotetrahexosylganglioside on severe traumatic brain injury in adults.American journal of translational research · 2022Article
- The Short and the Long of it: Timing of Mortality for Older Adults in a State Trauma System.The Journal of surgical research · 2021Article
- Hospitals with and without neurosurgery: a comparative study evaluating the outcome of patients with traumatic brain injury.Scandinavian journal of trauma, resuscitation and emergency medicine · 2021Observational
- Impact of US hospital center and interhospital transfer on spinal cord injury management: An analysis of the National Trauma Data Bank.The journal of trauma and acute care surgery · 2021Article
- Defining the representativeness heuristic in trauma triage: A retrospective observational cohort study.PloS one · 2019Observational
- Enduring Neuroprotective Effect of Subacute Neural Stem Cell Transplantation After Penetrating TBI.Frontiers in neurology · 2018Review
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
backgroundHead injury is an increasing contributor to death and disability, particularly among the elderly. Older patients are less likely to be treated at trauma centers, and head injury is the most common severe injury treated at non-trauma centers. We hypothesized that patients initially triaged to trauma centers would have lower rates of mortality and higher rates of discharge home without services than those treated at non-trauma centers. STUDY
designWe used the State Emergency Department and Inpatient Databases (2011 to 2012) for 6 states to conduct a retrospective cohort study of patients with severe, isolated head injury. Combined, these databases capture all visits to non-federal emergency departments. We compared in-hospital mortality and discharge status for all adults and for the subgroup aged 65 years or older who initially presented to either a trauma center or a neurosurgery-capable non-trauma center. To account for selection bias, we used differential distance from patients' homes to a trauma center as an instrumental variable and performed a multivariable matched analysis.
resultsOf 62,198 patients who presented with severe, isolated head injury, 44.2% presented to non-trauma centers and 55.8% to trauma centers. In multivariable matched instrumental variable analysis, initial presentation to a trauma center was associated with no significant difference in overall mortality (-1.06%; 95% CI -3.36% to 1.19%), but a 5.8% higher rate of discharge home (95% CI 1.7% to 10.0%). Among patients aged 65 years or older, initial presentation to a trauma center was associated with a 3.4% reduction in mortality (95% CI 0.0% to 7.1%).
conclusionsPatients 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.
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