Background: The purpose of this study was to see any association of state designation level of trauma center in the incidence of pneumonia following severe head injury patients.

Methods: Patient information was retrieved from the National Trauma Data Bank Research Data Set v7.1. The inclusion criteria were: Blunt cerebral contusion injuried at street and highway. Severe head injury was identified via the Abbreviated Injury Scale (AIS) codes with the AIS score ≥3, age between 18 and 89 years, and survived for 48 hours and underwent tracheostomy at the Level I or II trauma centers. Pneumonia during the course of treatment was the primary outcome. Wilcoxon rank-sum test and chi-square test was used to compare the continuous variables. Multiple logistic regression models were used to assess the association between the trauma center level and pneumonia while controlling for potential confounding factors.

Results: Data from 542 TBI patients admitted during 2002-2006 were evaluated. 69% of these patients were admitted to level I trauma center. Patients who were treated at the Level I were similar to those who were treated at the Level II trauma center in terms of age (mena [SD]: 39.3 [17.1] vs. 40.5 [17.1] years, P=0.39), race distribution (P=0.11), Injury Severity Score (ISS) (32.9[12.3] vs. 32.4[12.9], P=0.34) and initial Glasgow Coma Scale (6.1[4.5] vs. 6.3[4.2], P=0.25). However, Level I center had treated more female patients (30.7% vs. 22.2%, P=0.04). When compared the outcomes, there were no significant difference between the Level I and the Level II trauma center interms of mortality (10.9% vs. 7.8%, P=0.26) and incidence of pneumonia (24.3% vs. 22.2%, P=0.59) respectively. From a mulitple logistic regression model, patients who were treated at Level I center had similar chance of developing pneumonia (odds ratio=1.21, 95% confidence interval: [0.41, 3.56], P=0.73), however, male gender and delayed tracheostomy (>7 days) significantly increased that chance.

Conclusion: Our study found that Level I and II trauma center had similar outcomes in terms of incidence of pneumonia and mortality. Pneumonia: 23.6% (128/542)