Traumatic Brain Injury A Roadmap for Accelerating Progress (2022) / Chapter Skim
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5 Acute Care After Traumatic Brain Injury
5 Acute Care After Traumatic Brain Injury
Pages 81-106
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From page 81... ...
A cute injury management immediately following traumatic brain injury (TBI) focuses on minimizing complications, identifying sequelae, and optimizing long-term outcomes.
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From page 82... ...
During the acute care process, patients are often transferred in and out of settings that include the injury site, emergency medical transport vehicles, emergency departments (EDs) , hospital intensive care units (ICUs)
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From page 83... ...
Injury severity and presenting symptoms guide decisions on whether to transport patients to EDs and trauma centers, as well as on the medical interventions provided. Acute care management emphasizes the prevention and mitigation of secondary injuries that increase morbidity and mortality, such as hypotension, hypoxia, and increased intracranial pressure that may occur because of the primary insult to the brain (Vella et al., 2017)
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From page 84... ...
worldwide to adopt the Glasgow Coma Scale and 1 None standardised outcome measures to assess head injuries. 2 To pressure Thereafter, the scale was increasingly used in clinical 3 To speech practice internationally and became an expected 4 Spontaneous component of research articles.13 The role of the scale in clinical practice was influentially Verbal response (V)
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From page 85... ...
Recent studies demonstrate that blood biomarkers can reliably predict the presence of intracranial bleeding on head CT, which could potentially reduce the volume of unnecessary CT studies in acute care settings. As discussed further below, these and other data helped support recent Food and Drug Administration (FDA)
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From page 86... ...
THE ROLE OF CLINICAL PRACTICE GUIDELINES IN INFORMING ACUTE TBI CARE Clinicians draw on evidence-based clinical practice guidelines (CPGs) , where available, to inform their choices about patient care and interventions across the range of TBI severity.
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From page 87... ...
• CDC's Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury among Children (Lumba-Brown et al., 2018) • Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, 3rd Edition: Update of the Brain Trauma Foundation Guidelines (Kochanek et al., 2019)
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From page 88... ...
Panel discussion during virtual workshop for the Committee on Accelerating Progress in Traumatic Brain Injury Research and Care, March 18, 2021.
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From page 89... ...
.4 Prehospital Acute Care Management While prehospital care is guided by the concept that care provided during the first 60 minutes following traumatic injury ("the Golden Hour") is critical in determining whether a patient survives the injury, it has become increasingly clear that secondary insults occurring beyond the Golden Hour increase the risk for mortality and disability (Stocchetti et al., 2017)
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Panel discussion during virtual workshop for the Committee on Accelerating Progress in Traumatic Brain Injury Research and Care, March 18, 2021.
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From page 91... ...
Care includes managing the airway, blood oxygenation, intracranial pressure, and hemorrhaging. Standardized guidelines are especially needed on how to prevent hemodynamic deterioration in TBI patients during acute care.
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From page 92... ...
A major barrier to delivering optimal management for these patients is the lack of objective tools for detecting lesion progression prior to the development of overt clinical signs or radiographic indication. Recently, a number of authors have questioned the utility of 6-hour repeat brain CT scans in GCS 13–15 TBI patients with traumatic intracranial lesions (Joseph et al., 2014; Rosen et al., 2018)
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From page 93... ...
Absent more comprehensive clinical care guidelines, the provision of optimal care for acute TBI faces multiple challenges (Brolliar et al., 2016; Carney et al., 2017; Kochanek et al., 2019) . Limited data on certain topics and variable adherence to existing guidelines both contribute to gaps in acute care for TBI.
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From page 94... ...
Given that other TBI tests and treatments are predicated on ICP monitoring, the lack of standardization in this aspect of care results in unwarranted variability in acute TBI management. More robust clinical care guidelines are also needed to address important aspects of TBI care that lack a clear consensus, such as the use of tranexamic acid (Maas et al., 2021)
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From page 95... ...
Providing education and support to persons with TBI and caregivers starting in the acute care phase is especially important for those patients being discharged to home. And while the military has systems of care to provide post-acute services and long-term rehabilitation, patients can experience loss of continuity when transitioning from Department of Defense (DoD)
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From page 96... ...
Confounding Factors and Comorbidities During hospitalization and during the transition from acute to post-acute care for TBI, many patients have comorbidities and preexisting conditions that require ancillary services in addition to TBI care. In addition to other types of traumatic injuries, such comorbidities and preexisting conditions commonly include cardiovascular risk factors, such as hypertension, and mental health disorders, among others.
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From page 97... ...
Panel discussion during virtual workshop for the Committee on Accelerating Progress in Traumatic Brain Injury Research and Care, March 30, 2021.
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From page 98... ...
Presentation and panel discussion during virtual workshop for the Committee on Accelerating Progress in Traumatic Brain Injury Research and Care, March 16, 2021.
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From page 99... ...
2003. Identification and evaluation of patients with mild traumatic brain injury: Results of a national survey of level I trauma centers.
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2015. Recent trends in hospitalization and in-hospital mortality associated with traumatic brain injury in Canada: A nationwide, population-based study. Journal of Trauma and Acute Care Surgery 79(3)
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2019. Guidelines for the management of pediatric severe traumatic brain injury, third edition: Update of the Brain Trauma Foundation Guidelines.
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From page 102... ...
Recovery after mild traumatic brain injury in patients presenting to US level I trauma centers: A Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study.
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2014. ED disposition of the Glasgow Coma Scale 13 to 15 traumatic brain injury patient: Analysis of the Transforming Research and Clinical Knowledge in TBI study.
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2014. Acute care clinical indicators associated with discharge outcomes in children with severe traumatic brain injury. Critical Care Medicine 42(10)
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2021. Pathological computed tomography features associated with incomplete recovery and unfavorable outcome after mild traumatic brain injury: A TRACK-TBI study.
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