Regional Stabilization Before Transfer in Moderate Traumatic Brain Injury: Comparable Outcomes Within a Rural Hub-and-Spoke Trauma System

Background The Brain Trauma Foundation’s guidelines specifically highlight the need to determine optimal triage destination for moderate traumatic brain injury (modTBI) patients, particularly in rural settings where Level I trauma centers may be geographically distant. Methods Retrospective cohort analysis utilizing sequential adult patients (≥18 years) with modTBI, defined by a field Glasgow Coma Scale (GCS) score of 9-13, admitted to two Level-1 trauma centers (2017-2024). Patients were divided into two groups based on initial triage: initial assessment at regional centers with subsequent transfer (n = 60) vs direct admission to Level I trauma centers (n = 148). Outcomes included hospital discharge disposition, hospital interventions, complications, and functional outcomes as measured by the Glasgow Outcome Scale-Extended (GOSE) at six months. Statistical analysis involved chi-square and Mann-Whitney U tests, with sensitivity analyses to address missing six-month follow-up data. Results Baseline injury severity and imaging findings were comparable between groups. The Transfer group had fewer surgical interventions (26.7% vs 52.7%, P < .002). There were no significant differences in hospital mortality (21.7% vs 14.2%, P = 0.27), home discharge (28.3% vs 34.5%, P = 0.49), or hospital complications (23.3% vs 29.7%, P = 0.40). At six months, Favorable outcomes (GOSE 5-8) were comparable between groups (65.9% vs 74.8%, P = 0.38), as were six-month mortality rates (16.7.% vs 8.8%, P = 0.16). Sensitivity analyses remained robust under most missing data assumptions. Discussion Initial triage location did not significantly affect discharge disposition, complication rates, or six-month functional outcomes in modTBI patients. Hub-and-spoke triage appears safe for hemodynamically stable modTBI in rural trauma systems with established transfer networks.