Comparison of Outcomes at Trauma Centers versus Non-Trauma Centers for Severe Traumatic Brain Injury
- Authors
- Jeong, Tae Seok; Choi, Dae Han; Kim, Woo Kyung; KNTDB Investigators
- Issue Date
- Jan-2023
- Publisher
- 대한신경외과학회
- Keywords
- Brain injuries; traumatic · Trauma centers · Treatment outcome · Glasgow outcome scale · Mortality
- Citation
- 대한신경외과학회지, v.66, no.1, pp 63 - 71
- Pages
- 9
- Journal Title
- 대한신경외과학회지
- Volume
- 66
- Number
- 1
- Start Page
- 63
- End Page
- 71
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/90578
- DOI
- 10.3340/jkns.2022.0163
- ISSN
- 2005-3711
1598-7876
- Abstract
- Objective : Traumatic brain injury (TBI) is one of the most common injuries in patients with multiple trauma, and it associates with high post-traumatic mortality and morbidity. A trauma center was established to provide optimal treatment for patients with severe trauma. This study aimed to compare the treatment outcomes of patients with severe TBI between non-trauma and trauma centers based on data from the Korean Neuro-Trauma Data Bank System (KNTDBS).
Methods : From January 2018 to June 2021, 1122 patients were enrolled in the KNTDBS study. Among them, 253 patients from non-traumatic centers and 253 from trauma centers were matched using propensity score analysis. We evaluated baseline characteristics, the time required from injury to hospital arrival, surgery-related factors, neuromonitoring, and outcomes.
Results : The time from injury to hospital arrival was shorter in the non-trauma centers (110.2 vs. 176.1 minutes, p=0.012). The operation time was shorter in the trauma centers (156.7 vs. 128.1 minutes, p=0.003). Neuromonitoring was performed in nine patients (3.6%) in the non-trauma centers and 67 patients (26.5%) in the trauma centers (p<0.001). Mortality rates were lower in trauma centers than in non-trauma centers (58.5% vs. 47.0%, p=0.014). The average Glasgow coma scale (GCS) at discharge was higher in the trauma centers (4.3 vs. 5.7, p=0.011). For the Glasgow outcome scale-extended (GOSE) at discharge, the favorable outcome (GOSE 5–8) was 17.4% in the non-trauma centers and 27.3% in the trauma centers (p=0.014).
Conclusion : This study showed lower mortality rates, higher GCS scores at discharge, and higher rates of favorable outcomes in trauma centers than in non-trauma centers. The regional trauma medical system seems to have a positive impact in treating patients with severe TBI.
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