Traumatic Brain Injuries and How Just Following The Guidelines Can Saves Lives
Dr. Jamshid Ghajar, president of the Brain Trauma Foundation said, “Traumatic brain injury is the leading cause of death and disability in young people. Developing evidence-based guidelines and putting them into practice to improve outcomes are key priorities for the Brain Trauma Foundation.” Recently, a study showed remarkable reduction in deaths attributed to TBI in New York State.
Researchers documented a reduction in deaths of patients hospitalized in New York State with severe traumatic brain injury (TBI) between 2001 and 2009. The Brain Trauma Foundation, in collaboration with the American Association of Neurological Surgeons, published “Guidelines for Management of Severe Traumatic Brain Injury” in 1986.
Researchers studied data from 22 trauma centers in New York State. Between 2001 and 2009, the drop in deaths at the trauma centers undeniably correlated to increased adherence to tenets of the Guidelines, particularly recommendations on monitoring of brain pressure and management of brain perfusion pressure.
As part of a quality improvement initiative supported by the New York State Department of Health, the Brain Trauma Foundation set up an online Internet database in 2001. The database contains data from pre-hospital sources, emergency departments, and intensive care units at 20 Level I and 2 Level II trauma centers in New York State.
With the database, known as TBI-trac®, trauma centers across the nation can upload data on patients with severe TBI. They are able to track adherence to the Guidelines. They can even test hypotheses that may lead to improvements in the Guidelines.
To track how effective the Guidelines have been in reducing the number of deaths due to severe TBI, Gerber examined data from the database for years 2001 through 2009, focusing on trends in adherence to the Guidelines. These trends were evaluated via data examination on intracranial pressure monitoring, nutritional intake, use of steroid medications, presence of systemic hypotension, and treatment of intracranial hypertension within the first 1 or 2 days of hospitalization.
Most remarkably, researchers examined changes in case fatality rates within 2 weeks after a severe TBI occurred. Studies reveal that approximately 85% of deaths from TBI occur during that time period.
The researchers saw a significant reduction in fatality rates from 22% to 13% over the 9-year period. There were signs that adherence to the Guidelines significantly increased over time, with use of intracranial pressure monitoring rising from 56% to 75% and adherence to recommended cerebral perfusion pressure treatment thresholds improving from 15% to 48%! Support for recommendations on nutrition increased from 41% to 50% and the proportion of patients with elevated intracranial pressure dropped from 42% to 29%.
Following the Guidelines’ recommendations concerning avoidance of steroid medications was high throughout the time period, and hospital rates of systemic hypotension in patients with severe TBI remained low.
The researchers found intracranial hypertension rates and death in patients with severe TBI decreased significantly over the 9-years, and decreases were related to increased monitoring of intracranial pressure and management of cerebral perfusion pressure. It follows that these are two major recommendations of the Guidelines.
Gerber and colleagues conclude that strict adherence to the Guideline’s recommendations re increased monitoring of intracranial pressure and management of cerebral perfusion pressure improved outcomes in patients with severe TBI. It seems a mystery why the “Guidelines for Management of Severe Traumatic Brain Injury”, published by The Brain Trauma Foundation, in collaboration with the American Association of Neurological Surgeons, has not been followed more strictly across the nation. This new study shows that following the Guidelines saves lives. Hopefully, New York will be an example to Florida and the entire nation. Traumatic Brain Injuries often lead to death, and if following a set of Guidelines can save lives and decrease fatalities, then why not?
Perhaps doctors who do not follow such established and documented Guidelines should be held accountable for the results. In a time where more and more news reports and showing high school football players and car accident victims dying due to a traumatic brain injury, this study can hopefully shed some new light on how doctors should handle the treatment of those suffering from a TBI.
If you or a loved one have suffered a traumatic brain injury, consider contacting an experienced attorney who has knowledge of brain injuries and could potentially assist you in getting compensation for any negligently caused injuries. Call today. (727)451-6900. For more information about TBI, please stay tuned to http://www.tampabaybraininjuryblog.com/ for updated information.
