@article{ref1,
title="Impact of trauma verification level on management and outcomes of combined traumatic brain and solid organ injuries: an NTDB retrospective review",
journal="American surgeon",
year="2024",
author="Plurad, David and Sheets, Nicholas W. and Dubina, Emily D. and Smith, Elliott and Chawla-Kondal, Bhani and Tariq, Ayesha",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND: Level-I and level-II trauma centers are required to offer equivalent resources since &quot;The Orange Book.&quot; This study evaluates differences between level-I and level-II management of solid organ injury (SOI) with traumatic brain injury (TBI). <br><br>METHODS: We conducted a retrospective review of the National Trauma Data Banks from 2013 to 2021 of adult (≥18 years), blunt trauma patients with both TBI and SOI treated at level-I or level-II trauma centers. <br><br>RESULTS: 48,479 TBI and SOI patients were identified, 32,611 (67.3%) at level-I centers. Unadjusted incidence of laparotomy was higher at level I (14.5% vs 11.7%, P < 0.001), and angiography rates were similar (3.3% vs 3.4%, P 0.717). Sub-group analysis of stable patients (SBP ≥100) showed an increase in nonoperative management at level II (87.3% vs 88.7%, P < 0.001) and decrease in laparotomy (9.9% vs 8.3%, P < 0.001). On logistic regression (LR), severe TBI, high-grade SOI, and level I trauma status were predictors of laparotomy. Logistic regression showed mild/moderate TBI with high-grade SOI and level II were associated with use of angiography. Unadjusted mortality rates were slightly different (14.8% vs 13.4%, P < 0.001), but there was no association with trauma level on LR. <br><br>DISCUSSION: Nonoperative management was seen more at level-II centers with laparotomy at level I. Subgroup analysis showed no difference in mortality in trauma levels. Matched patients for level I and II showed no statistical difference in management. Patients were treated similarly at both levels with similar outcomes and mortality.<p /> <p>Language: en</p>",
language="en",
issn="0003-1348",
doi="10.1177/00031348241257472",
url="http://dx.doi.org/10.1177/00031348241257472"
}