Featured Research

from universities, journals, and other organizations

Adherence to guidelines for severe traumatic brain injury saves lives

Date:
October 8, 2013
Source:
Journal of Neurosurgery Publishing Group
Summary:
Researchers found a significant reduction in the number of deaths of patients hospitalized in New York State with severe traumatic brain injury between 2001 and 2009. Data from 22 trauma centers in New York State were studied. The reduction in deaths at these centers corresponded to increased adherence to tenets of the "Guidelines for Management of Severe Traumatic Brain Injury."

Researchers found a significant reduction in the number of 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 the first edition of the "Guidelines for Management of Severe Traumatic Brain Injury" in 1986.

Data from 22 trauma centers in New York State were studied by researchers from Weill Cornell Medical College, the Brain Trauma Foundation, and Jamaica Hospital Medical Center in New York, and Oregon Health & Science University in Portland, Oregon. The reduction in deaths at the trauma centers between 2001 and 2009 corresponded to increased adherence to tenets of the Guidelines, particularly recommendations on monitoring of brain pressure and management of brain perfusion pressure. Detailed findings of this study are reported and discussed in "Marked reduction in mortality in patients with severe traumatic brain injury. Clinical article," by Linda M. Gerber, Ph.D., Ya-Lin Chiu, M.S., Nancy Carney, Ph.D., Roger Härtl, M.D., and Jamshid Ghajar, M.D., Ph.D., published today online, ahead of print, in the Journal of Neurosurgery.

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, TBI-trac®, 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. Using this database, the trauma centers can upload data on patients with severe TBI, track adherence to the Guidelines, and 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 and colleagues examined data from the TBI-trac® database for the years 2001 through 2009, focusing on trends in adherence to the Guidelines over time. These trends were evaluated by examining data on intracranial pressure monitoring, use of steroid medications, nutritional intake, treatment thresholds for cerebral perfusion pressure and intracranial hypertension, presence of systemic hypotension, and treatment of intracranial hypertension within the first 1 or 2 days of hospitalization. The researchers also examined changes in the rate of case fatalities within the first 2 weeks after a severe TBI occurred. Studies have shown that approximately 85% of deaths from TBI occur during that time period. Data on 2347 cases of severe TBI were available for the analyses; the mortality analysis was based on 2320 cases due to a lack of sufficient documentation in the other 27 cases.

In their data analysis, the researchers noted a significant reduction in the case- fatality rate from 22% to 13% (p < 0.0001) over the 9-year period. There were obvious signs that adherence to the Guidelines significantly increased over time, with use of intracranial pressure monitoring rising from 56% to 75% (p < 0.0001), adherence to recommended cerebral perfusion pressure treatment thresholds improving from 15% to 48% (p < 0.0001), support for recommendations on nutrition increasing from 41% to 50% (p = 0.005), and the proportion of patients with elevated intracranial pressure (greater than 25 mm Hg) decreasing from 42% to 29% (p = 0.0001). Adherence to 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 that the rates of intracranial hypertension and death in patients with severe TBI decreased significantly over the 9-year period, and these decreases were concurrent with increased monitoring of intracranial pressure and management of cerebral perfusion pressure -- two major recommendations of the Guidelines. Gerber and colleagues conclude that adherence to the Guidelines' recommendations on increased monitoring of intracranial pressure and management of cerebral perfusion pressure improved outcomes in patients with severe TBI.

Summarizing the importance of the study, 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. This remarkable reduction in deaths in New York State exemplifies our continued commitment to evidence-based guidelines."


Story Source:

The above story is based on materials provided by Journal of Neurosurgery Publishing Group. Note: Materials may be edited for content and length.


Journal Reference:

  1. Linda M. Gerber, Ya-Lin Chiu, Nancy Carney, Roger Härtl, Jamshid Ghajar. Marked reduction in mortality in patients with severe traumatic brain injury. Journal of Neurosurgery, 2013; 1 DOI: 10.3171/2013.8.JNS13276

Cite This Page:

Journal of Neurosurgery Publishing Group. "Adherence to guidelines for severe traumatic brain injury saves lives." ScienceDaily. ScienceDaily, 8 October 2013. <www.sciencedaily.com/releases/2013/10/131008102545.htm>.
Journal of Neurosurgery Publishing Group. (2013, October 8). Adherence to guidelines for severe traumatic brain injury saves lives. ScienceDaily. Retrieved August 27, 2014 from www.sciencedaily.com/releases/2013/10/131008102545.htm
Journal of Neurosurgery Publishing Group. "Adherence to guidelines for severe traumatic brain injury saves lives." ScienceDaily. www.sciencedaily.com/releases/2013/10/131008102545.htm (accessed August 27, 2014).

Share This




More Mind & Brain News

Wednesday, August 27, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Have You Ever Been 'Sleep Drunk?' 1 in 7 Has

Have You Ever Been 'Sleep Drunk?' 1 in 7 Has

Newsy (Aug. 26, 2014) — A study published in the journal "Neurology" interviewed more than 19,000 people and found 15 percent suffer from being "sleep drunk." Video provided by Newsy
Powered by NewsLook.com
Does Medical Marijuana Reduce Painkiller Overdose Deaths?

Does Medical Marijuana Reduce Painkiller Overdose Deaths?

Newsy (Aug. 26, 2014) — A new study found fewer deaths from prescription drug overdoses in states that have legalized medical marijuana. But experts disagree on the results. Video provided by Newsy
Powered by NewsLook.com
Heart Group: E-Cigarettes May Help Smokers Quit

Heart Group: E-Cigarettes May Help Smokers Quit

AP (Aug. 25, 2014) — The American Heart Association's first policy statement on electronic cigarettes backs them as a last resort to help smokers quit and calls for more regulation to keep them away from youth. (Aug. 25) Video provided by AP
Powered by NewsLook.com
Doctors Push For Later Start Times As School Year Kicks Off

Doctors Push For Later Start Times As School Year Kicks Off

Newsy (Aug. 25, 2014) — The American Academy of Pediatrics is the latest group pushing for middle schools and high schools to start later, for the sake of their kids. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

    Environment News

    Technology News



    Save/Print:
    Share:  

    Free Subscriptions


    Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

    Get Social & Mobile


    Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

    Have Feedback?


    Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
    Mobile iPhone Android Web
    Follow Facebook Twitter Google+
    Subscribe RSS Feeds Email Newsletters
    Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins