Brain Trauma Foundation

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The Brain Trauma Foundation (BTF) was founded in 1986 to develop research on traumatic brain injury (TBI). Since its formation the foundation's mission has expanded to improving the outcome of TBI patients nationwide through working to implement evidence-based guidelines for prehospital and in-hospital care, quality-improvement programs, and coordinating educational programs for medical professionals.

Contents

TBI Guidelines

The Brain Trauma Foundation has developed the Guidelines for the Management of Severe Traumatic Brain Injury, first published in 1995 and revised twice, most recently in 2007. The foundation has also developed companion guidelines for pediatric TBI, prehospital management of TBI, early indicators and prognosis of severe TBI, surgical management of TBI, and field management for combat medics. The guidelines seek to create uniformity in TBI care all over the world. [1]

An independent analysis of the effect of the Brain Trauma Foundation's (BTF) guidelines on traumatic brain injury (TBI) outcome and cost savings by the Centers for Disease Control and Prevention (CDC) found that if the BTF guidelines were used more routinely, there would be a 50% decrease in deaths, improved quality of life and a savings of $262 million in annual medical costs, $43 million in annual rehabilitation costs and a lifetime societal cost of $3.84 billion. [2]

The guidelines have been endorsed by the American Association of Neurological Surgeons, the World Health Organization Neurotrauma Committee, and the New York State Department of Health. The guidelines have been distributed to all neurosurgeons in the United States. The guidelines provide medical personnel a protocol which has been proven to improve the survival and outcomes of TBI patients and has been shown to reduce rates of mortality. [3] [4] [5]

Intracranial pressure (ICP) monitoring

One of the main facets of the guidelines is the recommendation to monitor intracranial pressure in treating severe TBI patients. This process is called ICP Monitoring.[ citation needed ]

Related Research Articles

<span class="mw-page-title-main">Concussion</span> Medical condition

A concussion, also known as a mild traumatic brain injury (mTBI), is a head injury that temporarily affects brain functioning. Symptoms may include loss of consciousness; memory loss; headaches; difficulty with thinking, concentration, or balance; nausea; blurred vision; dizziness; sleep disturbances, and mood changes. Any of these symptoms may begin immediately, or appear days after the injury. Concussion should be suspected if a person indirectly or directly hits their head and experiences any of the symptoms of concussion. Symptoms of a concussion may be delayed by 1–2 days after the accident. It is not unusual for symptoms to last 2 weeks in adults and 4 weeks in children. Fewer than 10% of sports-related concussions among children are associated with loss of consciousness.

<span class="mw-page-title-main">Major trauma</span> Injury that could cause prolonged disability or death

Major trauma is any injury that has the potential to cause prolonged disability or death. There are many causes of major trauma, blunt and penetrating, including falls, motor vehicle collisions, stabbing wounds, and gunshot wounds. Depending on the severity of injury, quickness of management, and transportation to an appropriate medical facility may be necessary to prevent loss of life or limb. The initial assessment is critical, and involves a physical evaluation and also may include the use of imaging tools to determine the types of injuries accurately and to formulate a course of treatment.

<span class="mw-page-title-main">Traumatic brain injury</span> Injury of the brain from an external source

A traumatic brain injury (TBI), also known as an intracranial injury, is an injury to the brain caused by an external force. TBI can be classified based on severity ranging from mild traumatic brain injury (mTBI/concussion) to severe traumatic brain injury. TBI can also be characterized based on mechanism or other features. Head injury is a broader category that may involve damage to other structures such as the scalp and skull. TBI can result in physical, cognitive, social, emotional and behavioral symptoms, and outcomes can range from complete recovery to permanent disability or death.

Closed-head injury is a type of traumatic brain injury in which the skull and dura mater remain intact. Closed-head injuries are the leading cause of death in children under 4 years old and the most common cause of physical disability and cognitive impairment in young people. Overall, closed-head injuries and other forms of mild traumatic brain injury account for about 75% of the estimated 1.7 million brain injuries that occur annually in the United States. Brain injuries such as closed-head injuries may result in lifelong physical, cognitive, or psychological impairment and, thus, are of utmost concern with regards to public health.

<span class="mw-page-title-main">Diffuse axonal injury</span> Medical condition

Diffuse axonal injury (DAI) is a brain injury in which scattered lesions occur over a widespread area in white matter tracts as well as grey matter. DAI is one of the most common and devastating types of traumatic brain injury and is a major cause of unconsciousness and persistent vegetative state after severe head trauma. It occurs in about half of all cases of severe head trauma and may be the primary damage that occurs in concussion. The outcome is frequently coma, with over 90% of patients with severe DAI never regaining consciousness. Those who awaken from the coma often remain significantly impaired.

An induced coma – also known as a medically induced coma (MIC), barbiturate-induced coma, or drug-induced coma – is a temporary coma brought on by a controlled dose of an anesthetic drug, often a barbiturate such as pentobarbital or thiopental. Other intravenous anesthetic drugs such as midazolam or propofol may be used.

Post-concussion syndrome (PCS), also known as persisting symptoms after concussion, is a set of symptoms that may continue for weeks, months, or years after a concussion. PCS is medically classified as a mild traumatic brain injury (TBI). About 35% of people with concussion experience persistent or prolonged symptoms 3 to 6 months after injury. Prolonged concussion is defined as having concussion symptoms for over four weeks following the first accident in youth and for weeks or months in adults.

<span class="mw-page-title-main">Blunt trauma</span> Trauma to the body without penetration of the skin

Blunt trauma, also known as blunt force trauma or non-penetrating trauma, describes a physical trauma due to a forceful impact without penetration of the body's surface. Blunt trauma stands in contrast with penetrating trauma, which occurs when an object pierces the skin, enters body tissue, and creates an open wound. Blunt trauma occurs due to direct physical trauma or impactful force to a body part. Such incidents often occur with road traffic collisions, assaults, and sports-related injuries, and are notably common among the elderly who experience falls.

<span class="mw-page-title-main">Decompressive craniectomy</span> Neurosurgical procedure to treat swelling

Decompressive craniectomy is a neurosurgical procedure in which part of the skull is removed to allow a swelling or herniating brain room to expand without being squeezed. It is performed on victims of traumatic brain injury, stroke, Chiari malformation, and other conditions associated with raised intracranial pressure. Use of this surgery is controversial.

Targeted temperature management (TTM) previously known as therapeutic hypothermia or protective hypothermia is an active treatment that tries to achieve and maintain a specific body temperature in a person for a specific duration of time in an effort to improve health outcomes during recovery after a period of stopped blood flow to the brain. This is done in an attempt to reduce the risk of tissue injury following lack of blood flow. Periods of poor blood flow may be due to cardiac arrest or the blockage of an artery by a clot as in the case of a stroke.

Post-traumatic epilepsy (PTE) is a form of acquired epilepsy that results from brain damage caused by physical trauma to the brain. A person with PTE experiences repeated post-traumatic seizures more than a week after the initial injury. PTE is estimated to constitute 5% of all cases of epilepsy and over 20% of cases of acquired epilepsy.

Post-traumatic amnesia (PTA) is a state of confusion that occurs immediately following a traumatic brain injury (TBI) in which the injured person is disoriented and unable to remember events that occur after the injury. The person may be unable to state their name, where they are, and what time it is. When continuous memory returns, PTA is considered to have resolved. While PTA lasts, new events cannot be stored in the memory. About a third of patients with mild head injury are reported to have "islands of memory", in which the patient can recall only some events. During PTA, the patient's consciousness is "clouded". Because PTA involves confusion in addition to the memory loss typical of amnesia, the term "post-traumatic confusional state" has been proposed as an alternative.

Post-traumatic seizures (PTS) are seizures that result from traumatic brain injury (TBI), brain damage caused by physical trauma. PTS may be a risk factor for post-traumatic epilepsy (PTE), but a person having a seizure or seizures due to traumatic brain injury does not necessarily have PTE, which is a form of epilepsy, a chronic condition in which seizures occur repeatedly. However, "PTS" and "PTE" may be used interchangeably in medical literature.

Primary and secondary brain injury are ways to classify the injury processes that occur in brain injury. In traumatic brain injury (TBI), primary brain injury occurs during the initial insult, and results from displacement of the physical structures of the brain. Secondary brain injury occurs gradually and may involve an array of cellular processes. Secondary injury, which is not caused by mechanical damage, can result from the primary injury or be independent of it. The fact that people sometimes deteriorate after brain injury was originally taken to mean that secondary injury was occurring. It is not well understood how much of a contribution primary and secondary injuries respectively have to the clinical manifestations of TBI.

Traumatic brain injury can cause a variety of complications, health effects that are not TBI themselves but that result from it. The risk of complications increases with the severity of the trauma; however even mild traumatic brain injury can result in disabilities that interfere with social interactions, employment, and everyday living. TBI can cause a variety of problems including physical, cognitive, emotional, and behavioral complications.

Pupillometry, the measurement of pupil size and reactivity, is a key part of the clinical neurological exam for patients with a wide variety of neurological injuries. It is also used in psychology.

The Glasgow Outcome Scale (GOS) is an ordinal scale used to assess functional outcomes of patients following brain injury. It considers several factors, including a patient's level of consciousness, ability to carry out activities of daily living (ADLs), and ability to return to work or school. The scale provides a structured way to classify patient outcomes into five broad categories: death, vegetative state, severe disability, moderate disability, or good recovery.

Sleep disorder is a common repercussion of traumatic brain injury (TBI). It occurs in 30%-70% of patients with TBI. TBI can be distinguished into two categories, primary and secondary damage. Primary damage includes injuries of white matter, focal contusion, cerebral edema and hematomas, mostly occurring at the moment of the trauma. Secondary damage involves the damage of neurotransmitter release, inflammatory responses, mitochondrial dysfunctions and gene activation, occurring minutes to days following the trauma. Patients with sleeping disorders following TBI specifically develop insomnia, sleep apnea, narcolepsy, periodic limb movement disorder and hypersomnia. Furthermore, circadian sleep-wake disorders can occur after TBI.

Clinicians routinely check the pupils of critically injured and ill patients to monitor neurological status. However, manual pupil measurements have been shown to be subjective, inaccurate, and not repeatable or consistent. Automated assessment of the pupillary light reflex has emerged as an objective means of measuring pupillary reactivity across a range of neurological diseases, including stroke, traumatic brain injury and edema, tumoral herniation syndromes, and sports or war injuries. Automated pupillometers are used to assess an array of objective pupillary variables including size, constriction velocity, latency, and dilation velocity, which are normalized and standardized to compute an indexed score such as the Neurological Pupil index (NPi).

David Lozoff Brody is an American neurologist, academic, and author most known for his research on the clinical treatment of traumatic brain injury (TBI) and neurodegenerative diseases in civilian and military personnel. He is a Clinical Neurologist at the Walter Reed National Military Medical Center and a professor of Neurology at Uniformed Services University of the Health Sciences, as well as a professor of Neurology and Biomedical Engineering at Washington University.

References

  1. ↑ "Guidelines for the management of severe traumatic brain injury", Journal of Neurotrauma, vol. 24, no. Supplement 1, May 2007
  2. ↑ Faul, Mark; Wald, Marlena; Rutland Brown, Wesley; Sullivent, Ernest; Sattin, Richard (December 2007), "Using a Cost-Benefit Analysis to Estimate Outcomes of a Clinical Treatment Guideline: Testing the Brain Trauma Foundation Guidelines for the Treatment of Severe Traumatic Brain Injury.", Journal of Trauma-Injury Infection & Critical Care, vol. 63, no. 6, pp. 1271–1278, doi:10.1097/TA.0b013e3181493080, PMID   18212649
  3. ↑ Fakry, SM; Trask, AL; Waller, MA; Watts, Dorraine D. (2004), "Management of Brain-injured patients by an evidence-based medicine protocol improves outcomes and decreases hospital charges", J Trauma, vol. 56, no. 3, pp. 492–499, discussion 499–500, doi:10.1097/01.TA.0000115650.07193.66, PMID   15128118
  4. ↑ Palmer, S; Qureshi, A; Qureshi, Azhar; Palmer, Jacques; Shaver, Thomas; Borzatta, Marcello; Stalcup, Connie (2001), "The impact on outcomes in a community hospital setting of using the AANS traumatic brain injury guidelines Americans Associations for Neurologic Surgeons", J Trauma, vol. 50, no. 4, pp. 657–664', doi:10.1097/00005373-200104000-00010
  5. ↑ Patel, HC; Menon, DK; Tebbs, S; Hawker, R; Hutchinson, PJ; Kirkpatrick, PJ (2002), "Specialist neurocritical care and outcome from head injury.", Intensive Care Med, vol. 28, no. 5, pp. 547–553, doi:10.1007/s00134-002-1235-4, PMID   12029400
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