Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Comparison of Outcomes at Trauma Centers versus Non-Trauma Centers for Severe Traumatic Brain Injury

  • Tae Seok, Jeong (Department of Traumatology, Gil Medical Center, Gachon University College of Medicine) ;
  • Dae Han, Choi (Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine) ;
  • Woo Kyung, Kim (Department of Traumatology, Gil Medical Center, Gachon University College of Medicine) ;
  • KNTDB Investigators (Korea Neuro-Trauma Data Bank Committee, Korean Neurotraumatology Society)
  • Received : 2022.07.13
  • Accepted : 2022.08.22
  • Published : 2023.01.01
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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.

Keywords

Acknowledgement

This work was supported by the Gachon University research fund of 2020 (GCU-2020-202005430001). Authors are thankful to members of the KNTDB investigators : Jung Hwan Lee (Pusan National University Hospital), In Bok Chang (Hallym University Sacred Heart Hospital), Ki Seong Eom (Wonkwang University Hospital), Eun Sung Park (Wonkwang University Hospital), Jong Yeon Kim (Wonju Severance Christian Hospital), Min Kyun Na (Hanyang University Medical Center), Jeong Ho Lee (Daegu Fatima Hospital), Kwang Wook Jo (Bucheon St. Mary's Hospital), Han Seung Ryu (Chonnam National University Hospital), Kyung Hwan Kim (Chungnam National University Hospital), Yu Deok Won (Hanyang University Guri Hospital), Min Su Kim (Ulsan university hospital), Jin Gyu Choi (Yeouido St. Mary's Hospital), Sae Min Kwon (Keimyung University Hospital), Jae Sang Oh (Soonchunhyang University Hospital), and Soon O Hong (Seoul Medical Center).

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