{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T08:14:57Z","timestamp":1788077697963,"version":"build-2784847793"},"reference-count":25,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Brain Trauma Foundation\u2019s 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective cohort analysis utilizing sequential adult patients (\u226518 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Baseline injury severity and imaging findings were comparable between groups. The Transfer group had fewer surgical interventions (26.7% vs 52.7%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .002). There were no significant differences in hospital mortality (21.7% vs 14.2%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.27), home discharge (28.3% vs 34.5%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.49), or hospital complications (23.3% vs 29.7%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.40). At six months, Favorable outcomes (GOSE 5-8) were comparable between groups (65.9% vs 74.8%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.38), as were six-month mortality rates (16.7.% vs 8.8%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.16). Sensitivity analyses remained robust under most missing data assumptions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348261484510","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T19:27:17Z","timestamp":1787858837000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Regional Stabilization Before Transfer in Moderate Traumatic Brain Injury: Comparable Outcomes Within a Rural Hub-and-Spoke Trauma System"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1059-5134","authenticated-orcid":false,"given":"Julian Michael","family":"Burwell","sequence":"first","affiliation":[{"name":"Geisinger Commonwealth School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nia","family":"Long","sequence":"additional","affiliation":[{"name":"Geisinger Commonwealth School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Huang","sequence":"additional","affiliation":[{"name":"Geisinger Commonwealth School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhudjerry","family":"Arnet","sequence":"additional","affiliation":[{"name":"Geisinger Commonwealth School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Lopez","sequence":"additional","affiliation":[{"name":"Geisinger Health Systems"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemens Maria","family":"Schirmer","sequence":"additional","affiliation":[{"name":"Geisinger Health Systems"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.4103\/jnrp.jnrp_310_18"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2023.2187905"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.1080\/02699052.2024.2361641"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.1080\/02699052.2022.2034948"},{"key":"e_1_3_7_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-016-0253-y"},{"key":"e_1_3_7_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2021.09.433"},{"key":"e_1_3_7_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyy354"},{"key":"e_1_3_7_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2019.12.005"},{"key":"e_1_3_7_10_2","unstructured":"Best Practice Guidelines. 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