Can TBI Be Managed Without Neurosurgical Consultation?
The standard of care in most high level trauma centers is to involve neurosurgeons in the care of patients with significant traumatic brain injury (TBI). However, not all hospitals that take care of trauma patients have immediate availability of this resource. An interesting paper looked at management of these patients by acute care surgeons.
The authors retrospectively reviewed all their patients who had a TBI and positive head CT managed with or without neurosurgery consultation over a two year period. They matched the patients with and without neurosurgical consultation for age, GCS, AIS-Head and presence of skull fracture and intracranial hemorrhage (parenchymal, epidural, subdural, subarachnoid). Neurosurgeons were available to the no-consult group if things went awry.
A total of 180 patients with and 90 patients without neurosurgical involvement were reviewed. Here are the interesting findings:
Hospital admission rate was identical for both groups (88%)
ICU admission was significantly higher if neurosurgeons were involved (20% vs 44%)
Repeat head CT was ordered more than 3 times as often by neurosurgeons (20% vs 86%)
Post-discharge head CT was ordered more often by neurosurgeons, but was not significantly higher (5% vs 12%)
There were no neurosurgical interventions, in-hospital mortalities, or readmissions within 30 days in either group
Based on this experience, the hospital adopted a set of guidelines for helping determine if neurosurgery should be consulted.
Bottom line: This work raises an interesting question: can general surgeons safely manage select patients with intracranial injury? The answer is probably yes. The majority of patients with mild to moderate TBI with small intracranial bleeds do well despite everything we throw at them. And it appears that surgeons use fewer resources managing them than neurosurgeons do. The keys to being able to use this type of system are to identify at-risk patients who really do need a neurosurgeon early, and having a quick way to get the neurosurgeon involved (by consultation or hospital transfer). Looking at the brain injury guidelines above, I am a little nervous about managing an epidural or contusion without one additional head CT. But this is certainly food for thought. As neurosurgery involvement in acute trauma declines, this concept will become more and more pertinent.
Taylor said one thing she loved about the Secret Sessions was that the fans invited became friends with one another. So I just want Taylor to know that iswearillloveyou, jtmaster13 and but-im-still-trying-to-find-it I were stuck in a car together for like 5 hours this weekend and we laughed and sang the whole way (except for when I got hangry, then we ate cupcakes). So Taylor, thanks for these friends, I love them so very much.
Wanted: Known all over as the Comedic Genius as well as Lurk Master, she is often spotted making insane video edits, or moving through the social media sites like a silent ninja, striking swiftly before vanishing without a second thought. She is armed with humor and sarcasm and considered very dangerous..Current Whereabouts: Last seen laughing in the face of danger.
Autologous stem cell therapy helpful in traumatic brain injury
The use of cell therapy after traumatic brain injury (TBI) in
children can reduce the amount of therapeutic interventions needed to
treat the patient, as well as the amount of time the child spends in
neurointensive care, according to research by The University of Texas
Health Science Center at Houston (UTHealth) Medical School.
TBI patients at Children’s Memorial Hermann Hospital
from 2000 to 2008 were divided into two groups: those who received
autologous bone marrow stem cells as part of a pilot study and those who
did not. Researchers used the Pediatric Intensity Level of Therapy
score to determine the degree of therapeutic intensity that was done to
reduce the cranial pressure below the danger zone.
For those who received the stem cells, researchers noted a
significant reduction in the score beginning at 24 hours post-treatment
through the first week. Patients who did not receive the stem cells
spent nearly twice as much time in neurointensive care – 15.6 days
compared to 8.2.
“Everything we do to treat traumatic brain injury is aimed at reducing the pressure in the brain,” said Charles S. Cox, Jr.,
M.D., principal investigator, professor and the George and Cynthia
Mitchell Distinguished Chair in Neurosciences at UTHealth and
co-director of the Texas Trauma Institute
at Memorial Hermann-Texas Medical Center. “We can measure the pressure
and there are medications to reduce the water in the brain but all of
those have risks associated with them, such as renal failure and kidney
problems. Our study showed that with stem cell therapy, we need to do
less intervention for a shorter period of time for the patient.”
Navy Bomb Technician Shares Story On Living With A TBI
brain injuries (TBIs) have become one of the most common injuries for
veterans of the wars in Iraq and Afghanistan. Recently, a US Navy explosive
ordinance technician shared his story of living with a TBI. Explosive ordinance
technicians are used to disarm roadside bombs and improvised explosive devices.
While on deployment in Iraq in 2004, the bomb technician was
injured by a roadside bomb, leaving him with a TBI. Afterwards, he had
difficulty organizing ideas and tasks, which ultimately damaged his career in
The story shows how the symptoms of TBIs can vary and in
some cases, damage careers. Depending on which area of the brain was injured,
symptoms can range from behavioral problems, cognitive issues and memory loss. Regardless,
TBIs can have unexpected consequences even years after the initial injury.
WANTED: Taylor Swift once asked, “Where are the sisters?” But now she’s made the tables turn, and we’re asking her the same question. Where is Kayla Ekwall? She may be hiding under the alias “Kale,” and she likely made the getaway in her Jeep Wrangler. With nothing in tow except her cross-stitching supplies and her golden doodle, she was last spotted pulling away from a lakeside getaway. Current whereabouts: like her bumper sticker reads, she’d “rather be at a Taylor Swift concert.”
I’m gonna send this kid some stuff for his bday. Everyone needs a helping hand sometimes. I’m posting this here because I know so many of you are kind hearted. If you’re interested in giving this kid something to smile about for his bday, check out the info above. Let’s do this.
WANTED: She’s got blonde hair, blue eyes, and a bucket hat. It’s Taylor Swift! No, it’s Justin Bieber! No. It’s Karissa Ekwall. And she’s winning hearts one game of beer pong at a time. She likes holding hands and jumping on her trampoline, but if you’re really trying to win her over, bribe her with gluten free sweets. Current whereabouts: inside a Turkey Hill Mint Chocolate Chip ice cream container.