Regionalized trauma care boosts TBI survival

For nearly 50 years, data has been accumulating regarding the effects of regionalized trauma systems on postinjury outcomes, and the verdict is clear: Having a system in place that is prepared to rapidly transport the severely injured to a trauma center provides the best opportunity to reduce morbidity and mortality in these patients. While this is true in a general sense, a penetrating injury to the torso is not the same as a TBI, with each requiring different resources and expertise for optimal management.

The group at Cleveland MetroHealth in Ohio sought to answer the question of whether or not regionalization of trauma services would demonstrate a benefit in patients with TBI. Reviewing 4 years' worth of data that coincided at its midpoint with the implementation of the Northern Ohio Trauma System (NOTS), the authors demonstrate a significant reduction in mortality in brain-injured patients, including a 28% reduction in patients with severe TBI on multivariate analysis.

Dr. Robert Winfield

While the mortality data is clearly impressive, the comments from the audience at EAST regarding the patients' functional outcomes are appropriate and timely; this is a weakness of most studies that utilize mortality as an endpoint, but it is perhaps an even more important consideration in a study of patients suffering TBI. Dr. Kelly has indicated that this is an area of active investigation for the group, and it will be eagerly anticipated. The authors' follow-up data will be of landmark importance if they are able to demonstrate that not only are lives of TBI patients saved through the regionalized delivery of trauma care, but that those patients are more likely to return home to their families, and are more capable of returning to work or school through earlier definitive and expert management.

In the end, the commendation from Dr. Stein regarding the ability of the NOTS group, which comprises three hospitals from two health systems, to coalesce into a highly functioning regional trauma system is prescient and reflective of an impressive achievement for the authors. It is a reminder that in a time of scarce resources and competition for health care dollars, maintaining a focus on patient care through a cooperative and collaborative approach will ultimately yield the best results for all involved.

Dr. Robert Winfield is an ACS Fellow and the chair of the ACS Resident and Associate Society, and assistant professor of trauma and acute and critical care surgery at Washington University, St. Louis.