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Original article
Can trauma surgeons keep up? A prospective cohort study comparing outcomes between patients with traumatic brain injury cared for in a trauma versus neuroscience intensive care unit
  1. Derek J Roberts1,2,
  2. Samuel D Leonard2,3,
  3. Deborah M Stein4,
  4. George W Williams5,6,
  5. Charles E Wade2,3,
  6. Bryan A Cotton2,3
  1. 1 Division of Vascular and Endovascular Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
  2. 2 Center for Translational Injury Research, The University of Texas Health Science Center, Houston, Texas, USA
  3. 3 Department of Surgery, The McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
  4. 4 Department of Surgery, The University of Maryland School of Medicine, Baltimore, Maryland, USA
  5. 5 Department of Anesthesiology, The McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
  6. 6 Department of Neurosurgery, The McGovern Medical School at the University of Texas Health Science Center, Houston, Texas, USA
  1. Correspondence to Dr Derek J Roberts, Division of Vascular and Endovascular Surgery, The Ottawa Hospital, Civic Campus, Ottawa, ON, Canada; Derek.Roberts01{at}gmail.com

Abstract

Background Although many patients with traumatic brain injury (TBI) are admitted to trauma intensive care units (ICUs), some question whether outcomes would improve if their care was provided in neurocritical care units. We sought to compare characteristics and outcomes of patients with TBI admitted to and cared for in a trauma versus neuroscience ICU.

Methods We conducted a prospective cohort study of adult (≥18 years of age) blunt trauma patients with TBI admitted to a trauma versus neuroscience ICU between May 2015 and December 2016. We used multivariable logistic regression to estimate an adjusted odds ratio (OR) comparing 30-day mortality between cohorts.

Results In total, 548 patients were included in the study, including 207 (38%) who were admitted to the trauma ICU and 341 (62%) to the neuroscience ICU. When compared with neuroscience ICU admissions, patients admitted to the trauma ICU were more likely to have sustained their injuries from a high-speed mechanism (71% vs. 34%) and had a higher Injury Severity Score (ISS) (median 25 vs. 16) despite a similar head Abbreviated Injury Scale score (3 vs. 3, p=0.47) (all p<0.05). Trauma ICU patients also had a lower initial Glasgow Coma Scale score (5 vs. 15) and systolic blood pressure (128 mm Hg vs. 136 mm Hg) and were more likely to have fixed or unequal pupils at admission (13% vs. 8%) (all p<0.05). After adjusting for age, ISS, a high-speed mechanism of injury, fixed or unequal pupils at admission, and field intubation, the odds of 30-day mortality was 70% lower among patients admitted to the trauma versus neuroscience ICU (adjusted OR=0.30, 95% CI 0.11 to 0.82).

Conclusions Despite a higher injury burden and worse neurological examination and hemodynamics at presentation, patients admitted to the trauma ICU had a lower adjusted 30-day mortality. This finding may relate to improved care of associated injuries in trauma versus neuroscience ICUs.

Level of evidence Prospective comparative study, level II.

  • intensive care unit
  • neurocritical care
  • trauma intensive care unit
  • polytrauma
  • traumatic brain injury

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/tsaco-2018-000229

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    Footnotes

    • Presented at This work was presented at the 31st Eastern Association for the Surgery of Trauma (EAST) Annual Scientific Assembly in Lake Buena Vista, Florida, USA, on January 10, 2018, by DJR (Quick Shot Paper).

    • Contributors Literature search: DJR, SDL, BAC. Study concept and design: All authors. Acquisition of study funding: CEW, BAC. Data collection: All authors. Analysis of data: DJR, DMS, BAC. Interpretation of data analyses: All authors. Drafting of the article: DJR, BAC. Critical revision of the article: All authors. Study supervision: BAC.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The institutional review board of the Memorial Hermann Hospital and UT Health provided ethical approval for the study.

    • Provenance and peer review Not commissioned; externally peer reviewed.