(118) Impact of Trauma Center Designation on Head and Neck Trauma Outcomes: A National Analysis

Introduction: Trauma care in the U.S. is increasingly regionalized, with complex injuries directed to higher-level centers. This study examines associations between trauma center designation and otolaryngologic interventions and outcomes in head and neck trauma to inform equitable resource allocation and transfer protocols, especially for patients with limited access to higher-level centers.

Methods: Retrospective cohort study of adult patients with head and neck trauma identified in the 2023 National Trauma Data Bank. Trauma center designation was the primary variable, and otolaryngologic interventions and clinical outcomes were evaluated.

Results: Among 370,992 patients, 220,414 were treated at Level I, 119,587 at Level II, and 30,991 at Level III–IV centers. Level I centers treated more severely injured patients (mean ISS 10.8 vs. 8.6 at Level III–V, p< 0.001; ISS>16: 24.5% vs. 16.3%, p< 0.001) and received more transfers (32.7% vs. 4.1%).

Rates of otolaryngologic surgery decreased with center level (Level I: 5.2%, II: 3.6%, III–V: 0.7%, p< 0.001), as did airway interventions (9.7%, 8.8%, 6.1%, p< 0.001).

Adjusted analyses showed Level III–V centers had lower odds of surgery (OR 0.15, 95% CI 0.13–0.18) and major complications (OR 0.53, 95% CI 0.49–0.57), with slightly lower mortality (OR 0.89, 95% CI 0.81–0.99). Level II centers had modestly higher odds of airway intervention (OR 1.06, 95% CI 1.03–1.09).

Conclusions: The trauma system regionalizes head and neck care, with specialized otolaryngologic interventions concentrated at Level I centers treating more severely injured patients. Despite higher unadjusted mortality, risk-adjusted outcomes support current protocols and highlight the importance of timely transfer to higher levels for patients needing advanced otolaryngologic care.