Conscious status is associated with the likelihood of trauma centre care and mortality in patients with moderate-to-severe traumatic brain injury

ABSTRACT

Objective: To assess the relationship between The International Classification of Diseases, Ninth Revision, Clinical Modification-derived conscious status and mortality rates in trauma centres (TC) vs. non-trauma centres (NTC).

Methods: Patients in the 2006–2011 Nationwide Emergency Department Sample meeting, The Centers for Disease Control and Prevention criteria for traumatic brain injury (TBI), with head/neck Abbreviated Injury Scale (AIS) scores ≥3 were included. Loss of consciousness (LOC) was computed for each patient. Primary outcomes included treatment at a level I/II TC vs. NTC and in-hospital mortality. We compared logistic regression models controlling for patient demographics, injury characteristics, and AIS score with identical models that also included LOC.

Results: Of 66,636 patients with isolated TBI identified, 15,761 (23.6%) had missing LOC status. Among the remaining 50,875 patients, 59.0% were male, 54.0% were ≥65 years old, 56.7% were treated in TCs, and 27.3% had extended LOC. Patients with extended LOC were more likely to be treated in TCs vs. those with no/brief LOC (71.1% vs. 51.4%, p < 0.001). Among patients aged <65, TC treatment was associated with increased odds of mortality [Adjusted Odds Ratio (AOR) 1.79]; accounting for LOC substantially mitigated this relationship [AOR 1.27]. Similar findings were observed among older patients, with reduced effect size.

Conclusion: Extended LOC was associated with TC treatment and mortality. Accounting for patient LOC reduced the differential odds of mortality comparing TCs vs. NTCs by 60%. Research assessing TBI outcomes using administrative data should include measures of consciousness.

KEYWORDS:

• TBI
• conscious
• trauma centre
• mortality

Acknowledgments

HAA, RSH, AOA, BJS, CGV, ERH, and EBS contributed to the concept and design of the study. HAA, RSH, AAO, BJS, JKC, and EBS were involved in data analysis. HAA, RSH, AOA, BJS, JKC, AE, DTE, CGV, ERH, and EBS significantly contributed to analysis, writing, and revising the manuscript. All authors have read and approved the submitted manuscript, which is not under consideration for publication elsewhere. Some content in the manuscript was previously presented at 74th Annual Meeting of AAST and Clinical Congress of Acute Care Surgery in Las Vegas, NV, September 9–12, 2015.

Declaration of interest

No authors report relevant conflicts of interest.