CDC Finding re: Severe Traumatic Brain Injury

0 comments

Posted on 23rd March 2009 by Gordon Johnson in Brain Injury

, , , , , , ,

One of the most difficult to answer and unfortunately way to often asked questions on our 800 number is about coma prognosis and treatment. A study cited on the Center for Disease Control’s website (CDC) discusses new research in this area. With the Natasha Richardson seemingly mild brain injury that turned deadly, these findings become even more relevant.

From the CDC website, http://www.cdc.gov/ncipc/dir/Brain_Trauma_Guidelines.htm

CDC Study Finds that Adoption of the Brain Trauma Foundation Guidelines Could Result in a Substantial Reduction in Traumatic Brain-Injury-Related Deaths

CDC Study Finds that Adoption of the Brain Trauma Foundation Guidelines Could Result in a Substantial Reduction in Traumatic Brain-Injury-Related Deaths coverThe December issue of the Journal of Trauma: Injury, Infection, and Critical Care features a study conducted by CDC on the effectiveness of adopting the Brain Trauma Foundation (BTF) in-hospital guidelines for the treatment of adults with severe traumatic brain injury (TBI).

The findings presented in this article demonstrate that widespread adoption of these guidelines could result in a 50% decrease in deaths, and a savings of approximately $288 million in medical and rehabilitation costs. In addition, the study concludes that adopting these guidelines could result in $3.8 billion—the estimated lifelong savings in annual societal costs for severely injured TBI patients.

This study demonstrates that routine use of these guidelines could result in a substantial reduction in deaths and medical, rehabilitative, and societal costs.

The BTF guidelines for in-hospital care were developed over 10 years ago, in collaboration with the American Association of Neurological Surgeons (AANS). Companion guidelines for pre-hospital care were prepared with the support of the National Highway Traffic Safety Administration (NHTSA) and issued later. Although disseminated widely, these guidelines need far greater implementation.

To purchase this special issue, access the publisher’s website.*
(CDC is unable to provide free copies because of copyright regulations.)

A great resource, but not distributed by the Federal Government, because of copyright restrictions. One really must wonder about the goals and objectives though of an organization called the Brain Trauma Association that is there to save lives in emergency situations, who restricts access to perhaps its most important educational goals. Some things should just simply be free of copyright. Were Federal tax dollars used for this research? How do non-profit organizations get their priorities so backwards?

VA quadruples payment to vets with brain injuries

0 comments

Posted on 23rd September 2008 by Gordon Johnson in Brain Injury

, , , , , , ,

Date: 9/23/2008 6:23 PM

By PAULINE JELINEK
Associated Press Writer

WASHINGTON (AP) _ The government is more than quadrupling monthly payments to some veterans suffering brain injuries, as the number of such war wounds mounts from the roadside bombings of Iraq and Afghanistan.

The new compensation is based on the assessment that even some troops who have the mildest form of traumatic brain injury could end up with chronic headaches, memory loss, anxiety or other symptoms that will hurt their chances of getting a job or job advancement — thus reducing their lifetime earnings by 40 percent.

In a regulation announced Tuesday by the Department of Veterans Affairs, officials changed the way they evaluate the injuries. Depending on the extent of their injuries, vets now can be judged up to 40 percent disabled in such cases. The previous rating of 10 percent for such injuries was set by a 1961 regulation.

The rating change means that an unmarried veteran, who now receives $117 monthly in compensation, could receive as much as $512. Extra money would also be calculated for troops with spouses and children.

Mild traumatic brain injury is basically a form of concussion that results from severe shaking of the brain after a blast. It can cause blurred vision, insomnia, irritability and other problems.

The VA change represents the “best judgment of medical experts about what the impact” of such injuries is and how best to evaluate veterans who come to the VA for help, said Tom Pamperin, a deputy director for the department’s compensation and pension service.

The change goes into effect in 30 days and those receiving compensation under the old system can have their cases reviewed.

Roughly 1.7 million American troops have served in Iraq and Afghanistan and a RAND Corporation study estimated early this year that up to 320,000 may have suffered a traumatic brain injury. Officials say that the vast majority of the cases are mild — and that most veterans recover in weeks or months. The new, higher disability rating is for the smaller percentage who suffer permanent damage, Pamperin said.

The extra disability compensation is expected to cost nearly $124 million through 2017. That’s based on the assumption that the number of troops who get such payments will rise steadily in the coming years to 5,100 for 2017 from about 800 new cases a year now, Pamperin said.

He said about 200 troops with brain injuries annually went to the VA before the start of the Iraq war, where insurgent use of roadside explosives and car-bombs has made brain injuries, amputations, burns and post-traumatic stress disorder the vast majority of wounds from the campaign. Insurgents are also increasingly using explosives in Afghanistan.

Officials believe compensation levels are already correct for troops with moderate and severe traumatic brain injury that can involve open head wounds.

Though most troops with the severe cases already can be rated at 100 percent disabled, an increase has been approved for additional care they might need. That is, a single vet who needs assisted care can get $3,145 a month compared to the current $2,527 payment.

___

On the Net:

Department of Veterans Affairs www.va.gov

Copyright 2008 The Associated Press.

Guidelines for Coma Management

0 comments

Posted on 4th March 2008 by Gordon Johnson in Brain Injury

, , , , , ,

One of the most difficult challenges in being a brain injury attorney and an advocate, is struggling with what to tell people when they call up and their loved one is in a coma. The Brain Injury Law Group is here to a significant degree, because that was one of the challenges we faced when we first started doing web advocacy. We created http://waiting.com in 1997, with a sense of urgency to help those who were waiting for word as to whether their loved one would ever awake. The story of our frustration with the Brain Injury Association’s refusal to accept our offer of help to create such a page, and our decision to do it ourselves, is well explained on that page.

The Brain Trauma foundation is an organization which shares a similar advocacy to help those in a coma, and I received this email from them today, covering the guidelines to assist medical professionals dealing with coma patients. To get to those links, click here: http://www.guideline.gov/whatsnew/newthisweek.aspx#date

What these new guidelines don’t call for, which I believe they should, is the use of funtional imaging, such as PET scans or fMRI to tell the degree to which there is sufficient brain function going on in the comatose person, to predict any reasonable chance of recovery. Coma guidance from doctors is far too much “we will just have to wait and see” and most times, from a very pessimistic outlook. I believe that PET scans and fMRI should be routinely used to give guidance to the family, when they are trying to make that awful decision as to whether there is enough chance of a satisfactory recovery, to keep trying to save the life of the comatose person. We always counsel prayer and inner searching. But when there are tools out there that could be used to provide more meaningful information on what is going on inside of that skull, we believe they should be used. I have instructed the person who is my health care power of attorney to demand that I have a functional imaging test if I am ever in that situation, and there is no valid reason why doctors don’t do the same.

They Brain Trauma Association has guidelines on the following:

Anesthetics, analgesics, and sedatives.
Antiseizure prophylaxis.
Blood pressure and oxygenation.
Brain oxygen monitoring and thresholds.
Cerebral perfusion thresholds.
Deep vein thrombosis prophylaxis.
Hyperosmolar therapy.
Hyperventilation.

Indications for intracranial pressure monitoring.
Infection prophylaxis
Intracranial pressure thresholds.
Nutrition.
Prophylactic hypothermia.
Steroids.