Hospitalized Traumatic Brain Injury: Low Trauma Center Utilization and High Interfacility Transfers among Older Adults

Abstract

Objective Guidelines suggest that Traumatic Brain Injury (TBI) related hospitalizations are best treated at Level I or II trauma centers because of continuous neurosurgical care in these settings. This population-based study examines TBI hospitalization treatment paths by age groups. Methods Trauma center utilization and transfers by age groups were captured by examining the total number of TBI hospitalizations from National Inpatient Sample (NIS) and the number of TBI hospitalizations and transfers in the Trauma Data Bank National Sample Population (NTDB-NSP). TBI cases were defined using diagnostic codes. Results Of the 351,555 TBI related hospitalizations in 2012, 47.9% (n = 168,317) were directly treated in a Level I or II trauma center, and an additional 20.3% (n = 71,286) were transferred to a Level I or II trauma center. The portion of the population treated at a trauma center (68.2%) was significantly lower than the portion of the U.S. population who has access to a major trauma center (90%). Further, nearly half of all transfers to a Level I or II trauma center were adults aged 55 and older (p < 0.001) and that 20.2% of pediatric patients arrive by non-ambulatory means. Conclusion Utilization of trauma center resources for hospitalized TBIs may be low considering the established lower mortality rate associated with treatment at Level I or II trauma centers. The higher transfer rate for older adults may suggest rapid decline amid an unrecognized initial need for a trauma center care. A better understanding of hospital destination decision making is needed for patients with TBI.

Out-of-Hospital Triage of Older Adults With Head Injury: A Retrospective Study of the Effect of Adding “Anticoagulation or Antiplatelet Medication Use” as a Criterion

“…19-22 In addition, older adults are more frequently undertriaged to non-trauma centers than younger adults with similar injuries. 23,24 In response to these issues involving older adults with head injury, particularly those who are anticoagulated, the most recent field triage guidelines revised the special considerations criteria (Step 4) to include additional language for patients taking anticoagulants (including both anticoagulant and antiplatelet medications), stating “Patients with head injury are at high risk for rapid deterioration”. 18 The characteristics of EMS transport decisions and clinical outcomes in head injured patients meeting only Step 4 triage criteria, however, have not been previously described.…”

Diagnostic value of emergency medical services provider judgement in the identification of head injuries among trauma patients

“…Worldwide, 26-67% of patients with a severe head injury are not transported to a higher-level trauma centre [9][10][11]20,24]. The percentage depends greatly on the inclusion criteria, i.e.…”

“…Previous studies show that many patients with severe head trauma are not transported to a higher-level trauma centre [9][10][11][12][13]. The ability of EMS providers to accurately identify patients with a head injury is Correspondence unknown.…”

Out-of-hospital and Inter-hospital Under-triage to Designated Tertiary Trauma Centers among Injured Older Adults: A 10-year Statewide Geospatial-Adjusted Analysis

“…However, it should be noted that inter-facility triage patterns may vary with specific injuries; Faul et al using data from the National Inpatient Sample (NIS) and the National Trauma Data Bank (NTDB), observed a higher proportion of inter-facility transfers to Level I/II among older adults with traumatic brain injury (TBI). 27 …”