Nav: Home

Patients with head injuries do better when treated by trauma centers, even if it means bypassing other hospitals

March 01, 2018

PHILADELPHIA -- Patients who sustain severe head injuries tend to have better outcomes if they are taken to a designated trauma center, but 44 percent of them are first taken to hospitals without these specialized care capabilities, according to new research from the Perelman School of Medicine at the University of Pennsylvania. In the largest study of its kind, researchers found that patients under 65 were significantly more likely to fare well -- going home from the hospital without the need for nursing care or inpatient rehabilitation -- if taken to a trauma center first, rather than a non-trauma center. Patients over 65 were significantly less likely to die from their head injury when they went first to a trauma center.

The results, published today in the Journal of the American College of Surgeons, highlight a serious care disparity for these severely injured patients, and point to the need for systematic changes to improve care.

"These findings highlight a big opportunity to improve outcomes for head injury patients," said the study's senior author, M. Kit Delgado, MD MS, an assistant professor of Emergency Medicine and Epidemiology. "Regional trauma centers were set up to serve patients like these, but clearly many of them are still ending up in hospitals that may not have protocols, resources, and experience to appropriately treat these severe injuries."

Head injuries are a factor in about 50,000 deaths in the United States every year, and the incidence of these injuries appears to be rising. Between 2000 and 2010, emergency room visits and hospitalizations for head injuries increased from 521 to 824 per 100,000 people annually. Head injuries are also a major cause of hospitalization for the elderly, and also account for the majority of severe injuries undertriaged to non-trauma centers. Prior research has demonstrated that patients under 55 have significantly improved outcomes if treated in trauma centers, but these studies did not determine if older adults or patients with isolated head injuries had the same benefits. Since time to treatment may be critical and many non-trauma centers have neurosurgeons on staff capable of treating isolated head injuries, bypassing these hospitals to travel to further away trauma centers could theoretically lead to unintended consequences.

Delgado and colleagues, including lead author Elinore J. Kaufman, MD, MSHP, a resident in General Surgery at New York-Presbyterian Weill Cornell Medicine, who was a Penn Master of Science in Health Policy Research (MSHP) degree candidate at the time of the study, examined databases on emergency room visits for six states (NJ, NC, AZ, NY, FL, UT) during 2011-12. They identified 62,198 patients with severe, isolated head injuries who had been taken either to a trauma center (56 percent) or to a non-trauma center capable of performing neurosurgery (44 percent).

The ideal comparison of trauma center vs. non-trauma center outcomes would be a clinical trial in which patients are randomly assigned to one type of hospital or another. But, the authors say that for many logistical and ethical reasons that isn't feasible. However, the researchers had enough data to partly simulate a clinical trial setup by matching trauma-center and non-trauma center patients according to their sociodemographics, geography, cause, type, and severity of injury, and other variables. They then used the patient's relative distance from their home to the closest trauma center and non-trauma center with neurosurgery as a variable that effectively randomized where patients were treated.

In the resulting matched set of 21,823 cases, patients taken to trauma centers fared significantly better than those taken to non-trauma centers. Patients under 65 years old saw no mortality benefit, but had a 6.9 percent higher rate of a favorable discharge. Patients 65-and-older had a 3.4 percent lower risk of mortality with equal rates of being favorably discharged.

"These estimates of the benefits of sending patients to a trauma center are probably conservative, since we didn't include patients sent to non-trauma centers without neurosurgical capabilities," Kaufman said, adding that the complementary results for the two age groups are consistent with an overall improvement in outcomes. "If some of the older patients survived at trauma centers when they wouldn't have survived at non-trauma centers, that would have reduced mortality for that group but left many of those survivors in need of ongoing care and rehabilitation."

"It's good to now have evidence that demonstrates the benefit of traveling farther to a trauma center for these patients," Delgado said. "Hopefully, this will motivate EMS and trauma systems to double their efforts to triage patients with severe head injuries directly to trauma centers. There is major opportunity to improve outcomes as nearly half of these patients are being taken to non-trauma centers where their outcomes are worse."

The researchers suggest increasing compliance with current ambulance triage guidelines and future research to inform whether these guidelines should be revised to be more sensitive for picking up severe head injuries that may be less obvious at the time of presentation. Improvements in care at non-trauma centers would also reduce the differences in outcomes, Delgado said.
-end-
Other co-authors of the study included Ashkan Ertefaie of the University of Rochester and Dylan S. Small and Daniel N. Holena, of Penn Medicine.

Funding for the research was provided in part by the National Heart, Lung and Blood Institute

(K08HL131995), National Institute on Aging (R03AG052117), and the National Institute for Child Health and Development (K23HD090272).

Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $6.7 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 20 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $392 million awarded in the 2016 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center -- which are recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report -- Chester County Hospital; Lancaster General Health; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2016, Penn Medicine provided $393 million to benefit our community.

University of Pennsylvania School of Medicine

Related Clinical Trial Articles:

Treatment of migraine pain in randomized clinical trial
Adults experiencing a migraine of moderate or severe severity took the drug ubrogepant or placebo and reported if after two hours they were free of pain and of their most bothersome migraine-associated symptom in this randomized clinical trial.
First entirely digital clinical trial encourages physical activity
As little as a daily ping on your phone can boost physical activity, researchers from the Stanford University School of Medicine and their collaborators report in a new study.
HIV vaccine nears clinical trial following new findings
A promising vaccine that clears an HIV-like virus from monkeys is closer to human testing after a new, weakened version of the vaccine has been shown to provide similar protection as its original version.
Sickle cell drug showing promise in clinical trial
An investigational drug for the treatment of sickle cell disease is showing early promise in clinical trials for impacting biomarkers of the disease in patients, reported UConn School of Medicine researchers.
Meditation goes digital in new clinical trial
Scientists at UC San Francisco have developed a personalized digital meditation training program that significantly improved attention and memory in healthy young adults -- a group already at the peak of brain health -- in just six weeks.
Could blockchain ensure integrity of clinical trial data?
UC San Francisco researchers have created a proof-of-concept method for ensuring the integrity of clinical trials data with blockchain.
Eating crickets can be good for your gut, according to new clinical trial
A new clinical trial shows that consuming crickets can help support the growth of beneficial gut bacteria and that eating crickets is not only safe at high doses but may also reduce inflammation in the body.
Idera Pharmaceuticals presents clinical data from the ILLUMINATE-204 trial of the combination of tilsotolimod and ipilimumab for anti-PD-1 refractory metastatic melanoma at the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting
Idera Pharmaceuticals Inc., a clinical-stage biopharmaceutical company developing toll-like receptor and RNA therapeutics for patients with rare cancers and rare diseases, announced results from the ongoing ILLUMINATE-204 trial investigating tilsotolimod, Idera's intratumorally-delivered Toll-like Receptor 9 agonist, in combination with ipilimumab (Yervoy®).
Clinical trial eligibility criteria a growing obstacle
Despite a decade-long call for simplification of clinical trials, the number of criteria excluding patients from participating in clinical trials for lung cancer research continues to rise.
Clinical trial looks at tramadol for opioid withdrawal
A randomized clinical trial published by JAMA Psychiatry compared tramadol extended-release with clonidine and buprenorphine for the management of opioid withdrawal symptoms in patients with opioid use disorder in a residential research setting.
More Clinical Trial News and Clinical Trial Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Uncharted
There's so much we've yet to explore–from outer space to the deep ocean to our own brains. This hour, Manoush goes on a journey through those uncharted places, led by TED Science Curator David Biello.
Now Playing: Science for the People

#556 The Power of Friendship
It's 2020 and times are tough. Maybe some of us are learning about social distancing the hard way. Maybe we just are all a little anxious. No matter what, we could probably use a friend. But what is a friend, exactly? And why do we need them so much? This week host Bethany Brookshire speaks with Lydia Denworth, author of the new book "Friendship: The Evolution, Biology, and Extraordinary Power of Life's Fundamental Bond". This episode is hosted by Bethany Brookshire, science writer from Science News.
Now Playing: Radiolab

Dispatch 1: Numbers
In a recent Radiolab group huddle, with coronavirus unraveling around us, the team found themselves grappling with all the numbers connected to COVID-19. Our new found 6 foot bubbles of personal space. Three percent mortality rate (or 1, or 2, or 4). 7,000 cases (now, much much more). So in the wake of that meeting, we reflect on the onslaught of numbers - what they reveal, and what they hide.  Support Radiolab today at Radiolab.org/donate.