Impact of Admission Route on In-Hospital Mortality in Patients with Traumatic Brain Injury: A Retrospective Observational Study of a Single Major Trauma Center in South Korea

TL;DR

This study finds that being admitted directly to a trauma center versus being transferred from another hospital does not significantly affect mortality in traumatic brain injury patients after adjusting for factors like age and injury severity.

Contribution

The study provides evidence that inter-hospital transfer does not independently increase mortality in traumatic brain injury patients after adjusting for key clinical factors.

Findings

Crude mortality was higher in directly admitted patients compared to transferred patients.

Admission route was not independently associated with mortality after adjusting for age and injury severity.

Older age and lower GCS motor scores were consistently linked to higher mortality.

Abstract

Background/Objectives: The optimal transport strategy for patients with traumatic brain injury (TBI) remains debated, particularly in trauma systems where inter-hospital transfer is common. Whether secondary transfer independently influences mortality after risk adjustment is unclear. This study aimed to evaluate the association between admission route and in-hospital mortality among patients with TBI at a major trauma center (MTC). Methods: This retrospective observational study included 417 patients with TBI and an Abbreviated Injury Scale (AIS) head score ≥ 3 (direct admission: 245; inter-hospital transfer: 172). Severe TBI was defined as a total Glasgow Coma Scale (GCS) score ≤ 8 or the need for advanced airway management. Multivariable logistic regression was performed to assess whether admission route was independently associated with in-hospital mortality after adjustment for age, physiological status at MTC arrival, and injury severity. Subgroup analysis was conducted in patients with severe TBI. Results: Crude mortality was higher in the direct admission group than in the transfer group (40.8% vs. 26.7%; p = 0.003), despite significantly longer injury-to-trauma center arrival times in transferred patients (219.0 vs. 44.0 min). In multivariable analysis, admission route was not independently associated with mortality in the overall cohort (adjusted odds ratio [aOR] 0.75; 95% CI 0.44–1.28; p = 0.298) or in the severe TBI subgroup (n = 233; aOR 0.88; 95% CI 0.47–1.67; p = 0.705). Increasing age and lower GCS motor scores were consistently associated with higher mortality in both analyses. Conclusions: Inter-hospital transfer was not independently associated with increased in-hospital mortality among patients with TBI. After consideration of patient age and neurological severity, initial stabilization at a nearby hospital followed by transfer may be an acceptable transport strategy for patients who present with physiological instability requiring immediate resuscitative interventions.

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