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Invited Critique
December 15, 2008

Effect of Trauma Center Designation on Outcome in Patients With Severe Traumatic Brain Injury—Invited Critique

Arch Surg. 2008;143(12):1217. doi:10.1001/archsurg.143.12.1217

This article examines the outcomes of patients with head injuries using the NTDB and compares the outcomes of patients with head injuries between level 1 and level 2 centers. The results demonstrate higher rates of both mortality and complication in level 2 facilities. The implications of this kind of study suggest the need for further regionalization of these devastating injuries that constitute as much as 50% of trauma-related mortality in trauma centers. This relationship between level of resource commitment and outcome for head injuries has been suggested by others and has been one of the most dramatic outcomes of regionalization and development of trauma centers overall. The use of the NTDB to do this study is also useful. It avoids specific problems found in smaller geographically based studies. The fact that outcomes will improve as resources increase is not surprising.