ImportanceWide variations exist in traumatic brain injury (TBI) management strategies and transfer guidelines across the country.ObjectiveTo assess the outcomes of patients with TBI transferred to the American College of Surgeons (ACS) level I (LI) or level II (LII) trauma centers (TCs) on a nationwide scale.Design, Setting, and ParticipantsIn this secondary analysis of the ACS Trauma Quality Improvement Program database (2017 to 2020), adult patients with isolated TBI (nonhead abbreviated injury scale = 0) with intracranial hemorrhage (ICH) who were transferred to LI/LII TCs we re included. Data were analyzed from January 1, 2017, through December 31, 2020.Main Outcomes and MeasuresOutcomes were rates of head computed tomography scans, neurosurgical interventions (cerebral monitors, craniotomy/craniectomy), hospital length of stay, and mortality. Descriptive statistics and hierarchical mixed-model regression analyses were performed.ResultsOf 117 651 patients with TBI with ICH managed at LI/LII TCs 53 108; (45.1%; 95% CI, 44.8%-45.4%) transferred from other centers were identified. The mean (SD) age was 61 (22) years and 30 692 were male (58%). The median (IQR) Glasgow Coma Scale score on arrival was 15 (14-15); 5272 patients had a Glasgow Coma Scale score of 8 or less on arrival at the receiving trauma center (10%). A total of 30 973 patients underwent head CT scans (58%) and 2144 underwent repeat head CT scans at the receiving TC (4%). There were 2124 patients who received cerebral monitors (4%), 6862 underwent craniotomy/craniectomy (13%), and 7487 received mechanical ventilation (14%). The median (IQR) hospital length of stay was 2 (1-5) days and the mortality rate was 6.5%. There were 9005 patients (17%) who were discharged within 24 hours and 19 421 (37%) who were discharged within 48 hours of admission without undergoing any neurosurgical intervention. Wide variations between and within trauma centers in terms of outcomes were observed in mixed-model analysis.ConclusionsIn this study, nearly half of the patients with TBI managed at LI/LII TCs were transferred from lower-level hospitals. Over one-third of these transferred patients were discharged within 48 hours without any interventions. These findings indicate the need for systemwide guidelines to improve health care resource use and guide triage of patients with TBI.

中文翻译：

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转移到创伤中心的创伤性脑损伤患者的结局


重要性全国各地的创伤性脑损伤 （TBI） 管理策略和转移指南存在很大差异。目的评估在全国范围内转移到美国外科医师学会 （ACS） I 级 （LI） 或 II 级 （LII） 创伤中心 （TCs） 的 TBI 患者的预后。设计、设置和参与者在 ACS 创伤质量改进计划数据库（2017 年至 2020 年）的二次分析中，被转移到 LI/LII TC 的孤立性 TBI（非头部缩写损伤量表 = 0）伴颅内出血 （ICH） 的成年患者我们被纳入。分析了 2017 年 1 月 1 日至 2020 年 12 月 31 日的数据。主要结局和措施结局是头部计算机断层扫描率、神经外科干预率（脑监护仪、开颅手术/开颅手术）、住院时间和死亡率。进行了描述性统计和分层混合模型回归分析。结果在 LI/LII TCs 治疗的 117 651 例 ICH TBI 患者中，53 108 例;（45.1%;95% CI，44.8%-45.4%）被确定为从其他中心转移。平均 （SD） 年龄为 61 （22） 岁，男性 30 692 例 （58%）。抵达时格拉斯哥昏迷量表评分中位 （IQR） 为 15 （14-15）;5272 例患者在抵达接收创伤中心时格拉斯哥昏迷量表评分为 8 分或更低 （10%）。共有 30 973 例患者接受了头部 CT 扫描 （58%），2144 例患者在接受 TC 时接受了重复头部 CT 扫描 （4%）。有 2124 例患者接受了脑监护仪 （4%），6862 例接受了开颅手术/开颅手术 （13%），7487 例接受了机械通气 （14%）。中位 （IQR） 住院时间为 2 （1-5） d，死亡率为 6.5%。 有 9005 名患者 （17%） 在 24 小时内出院，19 421 名 （37%） 患者在入院后 48 小时内出院，未接受任何神经外科干预。在混合模型分析中观察到创伤中心之间和创伤中心内部在结果方面存在很大差异。结论在本研究中，近一半在 LI/LII TCs 治疗的 TBI 患者是从下级医院转诊的。这些转移的患者中有超过三分之一在 48 小时内出院，无需任何干预。这些发现表明需要全系统指南来改善医疗保健资源的使用并指导 TBI 患者的分诊。