Acute Subdural Hematoma: Direct Admission to a Trauma Center Yields Improved Results

Outcomes of Different Health Care Contexts for Direct Transport to a Trauma Center versus Initial Secondary Center Care: A Systematic Review and Meta-analysis

“…Databases from other sources were used in nine studies 29,52,54,57,58,61-63, 66 Retrospective review of medical records was performed in five studies. 17,42,56,68,69 The majority of studies were conducted in single level I/II trauma centers and their catchment areas, but eight were multiple level I/II centers studies: three from the USA, 53,54,63 three from Canada 21,28,51 one from Italy 62 and one from Australia. 30 Four USA studies 67,70,71,83 and one Norwegian study 68 classed their catchment area as 'rural'.…”

“…Most of the studies (n=14, 47%) were from the USA 18,20,29,[53][54][55]57,60,63,64,67,[69][70][71] Three were from Canada, 21,28,51 six from Europe that included two from Norway, 17,68 two from the Netherlands, 58,82 one from Italy 62 and one from Switzerland, 65 four from Asia (Hong Kong, 42,66 Japan, 61 and Taiwan 56 ), two from Australia and New Zealand 30,59 and one from South Africa. 52 The mean age of patients varied between regions, from an overall median age of 27 years in the South African study 52 to 44.9 years for the direct group and 45.9 years for the transfer group in the three Canadian studies.…”

“…In some trauma systems, patients with serious trauma were transported to a level I/II trauma center, bypassing closer secondary hospitals 20,54,57 whereas other systems transported patients to the nearest ED for stabilisation before transfer to a level I/II trauma center. 28,51,59,69,82 In some trauma systems the transfer policy varied according to the severity of the trauma or the proximity of the trauma center.…”

“…There was a higher proportion of patients with ISS > 40 in the direct group in a Hong Kong study. 42 The Galbraith plot showed that eleven of the studies 18,20,21,[28][29][30]54,57,60,66,69 were outside the 95% limits of studies that are expected to have effect estimates within two standard errors of the population effect confirming significant heterogeneity ( Figure B Supplementary Data). Six of these studies 18,20,21,28 ,29,30 were large studies with sample sizes greater than 3,000 patients.…”

“…Different time points were used for mortality assessment with hospital mortality that included the deaths in the Level I/II trauma center ED (and not the transferring hospitals' EDs) the most frequent time point for 13 US studies, 18,20,29,55,57,60,63,64,67,[69][70][71] two Canadian studies, 28,51 one European study, 65 the four Asian studies, 42,56,61,66 the two Australian / New Zealand studies 59 and the South African study. 52 Cheddie 52 also reported hospital mortality for patients who survived longer than 12 hours.…”