Severe Bumps on the Brain Can Kill

Traumatic brain injury deaths declined in trauma centers that follow care guidelines

(RxWiki News) The brain controls all bodily functions, and severe injury to the brain can not only impair those functions, but could also result in premature death.

Hoping to ease suffering for those with severe traumatic brain injury (TBI) and to boost their chances of survival, a group of people who treated TBI patients and monitored their status in 1996 developed the "Guidelines for Management of Severe Traumatic Brain Injury."

A new study suggests that those guidelines — which were last updated in 2007 — are helping to reduce the number of deaths stemming from TBI.

"Know the standards for treating brain trauma."

Linda Gerber, PhD, director of the Biostatistics and Research Methodology Core at Weill Cornell Medical College in New York City, was the study's lead author.

Gerber and her research team analyzed data on 2,320 TBI patients treated between 2001 and 2009 at 22 trauma centers across the state of New York. Center officials volunteered to have the care they deliver monitored.

The researchers focused on how closely the centers followed the TBI patient management guidelines that the Brain Trauma Foundation — in partnership with the American Association of Neurological Surgeons — developed to improve and provide a more consistent standard of care for TBI patients.

Specifically, the researchers tracked how many people died within the first two weeks of their trauma, and how well the centers treated patients to alleviate pressure on their brains during the first day or two of hospitalization. That pressure is caused when the brains swells or bleeds.

Also, among other information, the researchers reviewed how well the centers monitored brain pressure beyond those initial days of hospitalization, patients' nutritional intake, and whether steroids were ill-advisedly used to reduce swelling. According to the researchers, steroids can harm TBI patients.

The researchers of the New York centers found that the number of TBI-related deaths within the first two weeks after injury fell from 22 percent to 13 percent during those nine years of analysis. Those first two weeks are considered the most critical for TBI patients, researchers wrote.

Also, the researchers concluded that there was an overall increase in how well the trauma centers followed the 1996 guidelines. Over those nine years, the trauma centers:

  • saw their consistent use of monitors to gauge injured patients' brain pressure rise from 56 percent to 75 percent
  • saw their overall efforts to ensure proper blood flow to the brain jump from 15 percent to 48 percent
  • saw an overall drop from 42 percent to 29 percent in the number of patients with prolonged swelling or bleeding on their brains
  • increased their overall rate of compliance with guidelines for nutritional intake from 15 percent to 48 percent
  • stopped using steroids to lessen patients' brain swelling

While steroids may reduce brain swelling, they also can weaken patients' natural ability to fight infections, Kevin Crutchfield, MD, told dailyRx News.

As a result, many patients were developing infections such as pneumonia, said Dr. Crutchfield, director of the sports concussion program at Sinai Physician Partners in Baltimore, MD.

As for the guidelines, Dr. Crutchfield said they're smart and necessary: "Paying attention to the pressure inside the skull and how much blood gets to the brain tissue, when you improve that you'll have better outcomes, whether in [lowered] deaths or in lower levels of disability. It makes a world of good sense."

The researchers said the declining deaths were directly linked to how well the centers were following the guidelines, especially those related to monitoring brain pressure and management of blood flow in the brain. Those are the two most important guidelines, researchers wrote.

Nevertheless, researchers noted some continuing challenges at the New York trauma centers. The monitoring of pressure on the brain varied widely from trauma center to trauma center, and too little attention was paid to providing proper nutrition for TBI patients.

"This is especially concerning since previous work has shown the importance of early nutrition in these patients," researchers wrote.

During recent years, the researchers reported about 1.5 million people a year in the United States suffered TBI. As many as 50,000 of them each year died and 500,000 endured serious, long-range neurological problems.

The study was published online on October 8 in the Journal of Neurosurgery.

In addition to Weill Cornell, the researchers were based at the Brain Trauma Foundation in Manhattan, Jamaica Hospital Center in Queens, NY, and the Oregon Health & Science University in Portland.

The Brain Trauma Foundation, New York State Department of Health and New York-Presbyterian Hospital funded the study. The authors did not report any financial investments or other involvements that would shape study design, analysis or outcomes.

Review Date: 
October 5, 2013