Harris et al.

 (2008)

USA

Cohort

N=1,607

Population: TBI; Hospital 1 (n=691): Mean Age=38.3yr; Gender: Male=511, Female=180; Severity: Mild=414, Moderate=57, Severe=161. Hospital 2 (n=782): Mean Age=34.8yr; Gender: Male=633, Female=149; Severity: Mild=324, Moderate=77, Severe=91. Hospital 3 (n=134): Mean Age=34.6yr; Gender: Male=109, Female=25; Severity: Mild=82, Moderate=19, Severe=17.

Intervention: Data from 3 hospitals that provide neurosurgical care was extracted from a National Trauma Registry. Hospital 1 was in the USA and Hospitals 2/ 3, Jamaica.

Outcome Measure: Medical intervention use, Mortality rates, Glasgow Outcome Scale (GOS), and Functional Independence Measure (FIM).

1.        Patients cared for in hospital 1 had more severe head injuries, received more CT scans (p<0.0001), and were more likely to be admitted to the ICU than those in hospitals 2 and 3 (p<0.0001).

2.        Patients in hospital 1 were more likely to receive intracranial pressure monitoring.

3.        There were no statistically different differences in mortality rates between the three sites, except severe patients cared for in the USA had a decreased risk of mortality (OR 0.47, p=0.04).

4.        Patients cared for in the USA had lower mean GOS scores (p<0.0001) and lower FIM scores for self-feed (p=0.0003), locomotion (p=0.04), and verbal (p<0.0001).

DuBose et al. (2008)

USA

Case Control

N=16,035

Population: TBI; Mean Age=40.7yr; Gender: Male=11,169, Female=4866.

Intervention: Data on patients managed in level I and level II trauma centers was extracted from the National Trauma Data Bank and compared.

Outcome Measure: Injury Severity Scale (ISS), Mortality, Medical complications, and clinical procedures.

1.        After adjustments for patient differences, those managed in a level 2 trauma center had increased mortality, more complications and greater likelihood of progression of neurologic insult (all p<0.001).

2.        ISS>20, Age>55, GCS<8, admission to Level 2 trauma centers, penetrating mechanism and hypotension on admission were all significant risk factors for mortality (all p<0.001).