• Joseph J DuBose, Timothy Browder, Kenji Inaba, Pedro G R Teixeira, Linda S Chan, and Demetrios Demetriades.
• Los Angeles County Hospital, University of Southern California School of Medicine, Los Angeles, California 90033-4525, USA. jjd3c@yahoo.com
• Arch Surg. 2008 Dec 1;143(12):1213-7; discussion 1217.

ObjectiveTo determine the association of the American College of Surgeons (ACS) designation with outcomes in patients, specifically those with severe traumatic brain injuries.DesignA retrospective review. Logistic regression was performed for mortality, complications, and progression of initial neurologic insult.SettingData from the National Trauma Data Bank.PatientsA total of 16,037 patients with isolated severe head injury (head acute injury score, > or =3 and other body region abbreviated injury score, <3) classified into 2 groups (level 1 and level 2) according to ACS designation.ResultsPatients admitted to a level 2 center had higher mortality rates (13.9% vs 9.6%; P < .001), higher rates of complication (15.5% vs 10.6%; P < .001), and higher rates of progression of initial neurologic insult (2.0% vs 1.1%; P < .001). After adjustment for the factors that were different between the 2 groups, admission to a level 2 facility remained an independent predictor of mortality (adjusted odds ratio [OR], 1.57; 95% confidence interval [CI], 1.41-1.75; P < .001), complications (adjusted OR, 1.55; 95% CI, 1.40-1.71; P < .001), and progression of neurologic insult (adjusted OR, 1.78; 95% CI, 1.37-2.31; P < .001). Other independent risk factors for mortality were penetrating mechanism, age of 55 years or older, Injury Severity Score of 20 or higher, Glasgow Coma Scale score of 8 or lower, and hypotension (systolic blood pressure, <90 mm Hg).ConclusionPatients with severe traumatic brain injury treated in ACS-designated level 1 trauma centers have better survival rates and outcomes than those treated in ACS-designated level 2 centers.

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