Fatima Mikdashi, BS
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Hannah Frederick, BS
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Julianna Solomon, BS
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Joshua Olexa
University of Maryland Department of Neurosurgery
Baltimore, MD
Disclosure information not submitted.
Hammad Baqai, n/a
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Matthew Fairchild, n/a
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Grace Hollis, n/a
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Iana Sahadzic, n/a
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Kaitlyn Tang, n/a
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Muhammad Ullah, BS
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Austin Widjaja
Student
1The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA, United States
Disclosure information not submitted.
Isha Yardi, n/a
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Chris Yum, BS
Student
University of Maryland Research Associate Program, United States
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Manahel Zahid
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Daniel Najafali, BS
Student
University of Maryland Research Associate Program
Baltimore, Maryland, United States
Disclosure information not submitted.
Quincy Tran, MD, PhD, FCCM
Associate Professor
University of Maryland Medical Center
Baltimore, MD, United States
Disclosure information not submitted.
Title: Prehospital Transfer Location on Outcomes Of Traumatic Brain Injury Patients: A Case-Control Study
Introduction: Hematoma progression (HP) has been associated with worse outcomes among patients with traumatic brain injury (TBI). Patients with TBI are often evaluated first at a nearby facility prior to transfer to a higher trauma center. Prior studies have produced conflicting evidence regarding outcomes among patients with severe TBI who are transported first to a nontertiary center and later transferred to a Level 1 trauma center. In this study, we investigated the mortality of TBI patients who were admitted directly (DA) from the site of injury vs. those transferred to a Level 1 trauma center from another facility (IHT).
Methods: This is a retrospective analysis using 1:1 case-control matching of TBI patients admitted to a regional Level 1 trauma center between 1/2018 and 12/2019. Only patients who sustained traumatic intraparenchymal hemorrhage (IPH) or contusion and remained at the trauma center for longer than 24 hours were eligible. We matched DA with IHT according to age, admission Glasgow Coma Scale (GCS), hematoma volume, and type of hemorrhage. Outcomes were mortality and HP.
Results: We identified 254 patients and our matched cohorts included 112. HP was observed in 46 (41%) and 14 (12.5%) patients died. DA patients were at higher risk for HP (OR 4.5, 95% CI 1.97-10.84, p=0.001), as were those with a larger initial hematoma volume (OR 1.07, 95% CI 1.01-1.13, p=0.022). Stepwise multivariable logistic regression showed that increased age (OR 1.07, 95% CI 1.01-1.36, p=0.015), lower GCS at 24 hours (OR 0.59, 95% CI 0.44-0.80, p< 0.01) and high variability between highest and lowest systolic blood pressure values (blood pressure variability or BPV; OR 1.03, 95% CI 1.01-1.05, p=-.013) were associated with increased mortality. Our regression model demonstrated good discriminatory capability with an Area Under the Receiver Operating Curve of 0.92.
Conclusions: Patients admitted directly from the site of injury faced a higher rate of HP and mortality than did patients transferred from another facility. BPV was the only variable directly influenced by medical care that was associated with mortality. Clinicians should avoid high blood pressure fluctuations among TBI patients until more studies are available.