(121) Outcomes of Head and Neck Trauma at Level I vs. Level II Centers

Introduction: Trauma center designations are central to regional trauma systems, directing patients to facilities with the requisite resources for optimal outcomes. Although Level I and Level II centers offer comparable services, differences in scope and depth of care may be particularly relevant for complex subtypes such as head and neck (H/N) trauma. This study compares risk-adjusted outcomes for head and neck trauma patients treated at Level I versus Level II trauma centers.

Methods: A retrospective analysis of the National Trauma Data Bank from 2007-2015 identified adult patients with H/N trauma using ICD-9 codes. Multivariable regression assessed mortality, ventilator days, and hospital length stay between ACS-designated Level I and Level II centers, adjusting for demographics, injury severity, and mechanism of injury. Findings were validated with propensity score matching.

Results: A total of 351,265 patients were included. Level II patients were older (median age 43 vs 40 years, p < 0.001) with lower injury severity (median ISS 9 vs 10, p < 0.001). Level I centers more frequently managed high-energy mechanisms (MVT 46.4% vs 41.9%; penetrating injury 10.1% vs 8.3%; p < 0.001), whereas falls were more common at Level II centers (25.2% vs 19.6%, p < 0.001). Although crude mortality was higher at Level I centers (6.1% vs 5.3%, p < 0.001); risk-adjusted analyses demonstrated higher odds of mortality at Level II centers (aOR = 1.10, p < 0.001) despite shorter hospital stays (β = −0.44 days, p < 0.001), with no significant differences in ICU or ventilator days. Findings were consistent in the propensity-matched analysis.

Conclusions: Trauma center designation is independently associated with outcomes in H/N trauma, underscoring the need for refined triage and transfer protocols to optimize care for this high-risk population.