In our study, centralization of TBI patients significantly impacted short- and long-term outcomes. For TBI patients admitted to no-NSH centers, our results suggest that the least critically ill can effectively be managed in centers without neurosurgical capabilities.

Conversely, the most complex patients would benefit from being treated in high-volume, neuro-oriented ICUs.

A total of 232 patients, less than 5% of the eligible cohort, were admitted to no-NSH ICUs.

Each of them was matched to 3 NSH patients, leading to a study sample of 928 TBI patients where the no-NSH and NSH groups were well-balanced with respect to all of the variables included into the propensity score.

Patients admitted to no-NSH ICUs experienced significantly higher ICU and in-hospital mortality.

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