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Research Highlight: Adherence to Guidelines for Severe Traumatic Brain Injury Saves Lives

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Greater adherence to guidelines that outline proper management of severe traumatic brain injury has led to a significant drop in the number of New York patients who die from these injuries, according to a new study from Weill Cornell Medical College researchers.

Dr. Linda Gerber

The study was published Oct. 8 in the Journal of Neurosurgery by Dr. Linda Gerber, professor of public health and professor of epidemiology in medicine, Dr. Jamshid Ghajar, clinical professor of neurological surgery, Dr. Roger Hartl, chief of spinal surgery and neurotruama and professor of neurological surgery, and research biostatistician Ya-Lin Chiu from Weill Cornell, along with researchers from the Brain Trauma Foundation, Jamaica Hospital Medical Center in New York and Oregon Health & Science University.

At least 1.7 million Americans sustain some form of traumatic brain injury each year, with 275,000 people hospitalized and 52,000 people succumbing to their injuries, according to the U.S. Centers for Disease Control and Prevention. The Brain Trauma Foundation, in collaboration with the American Association of Neurological Surgeons and Congress of Neurological Surgeons published the first edition of the "Guidelines for Management of Severe Traumatic Brain Injury" in 1986. Even still, traumatic brain injuries are a contributing factor in nearly one-third of all injury-related deaths in the United States, according to the CDC.

Using an online database established by the Brain Trauma Foundation, the researchers analyzed data collected between 2001 and 2009 from 22 trauma centers in New York State. The database can be used to upload data on patients with severe TBI, track adherence to the guidelines, and test ideas that may lead to improvements in the guidelines.

The authors found a significant reduction in mortality rates, from 22 to 13 percent, while adherence to the guidelines increased — specifically with improved monitoring of pressure within the skull, management of blood flow in the brain, and administration of adequate nutritional support. Based on these results, they conclude that adherence to the guidelines' recommendations improved outcomes in patients with severe traumatic brain injuries.

"The marked and progressive decrease in mortality rates associated with an increase in adherence to evidence-based guidelines is very encouraging," said Dr. Gerber, lead author of the study. "These findings should stimulate efforts to further promote adherence to the guidelines."

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