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New Blood Test Claims to Predict Traumatic Brain Injury Outcomes

Blood levels of magnesium in patients who've just suffered traumatic brain injury could help predict outcomes according to a report presented at this week's annual meeting of the American Association of Neurological Surgeons in San Francisco. 

A team at the University of Pittsburgh Brain Trauma Research Center measured initial blood magnesium levels in 83 patients with severe brain injuries.

They found that 35 of the patients had normal magnesium levels when they arrived at the brain trauma center, while 48 had low levels. After six months, the patients with the low serum magnesium levels had significantly worse outcomes.

"The simplest interpretation of this data would support replenishing serum magnesium levels as soon as possible in traumatic brain injury patients. However, the utility of this approach needs to be proven," researcher Dr. Martina Stippler said in a prepared statement.

It's possible that blood magnesium levels in some patients are low due to the trauma itself, suggesting that low levels are associated with a more severe brain damage than might be indicated by other clinical and radiographic tests.

Rehabilitation of Soldiers With Head Injury and Brain Injury

Tonight, NBC News will air part two of a story on the consequences of brain injury to our soldiers in Iraq.  Part One which aired on Tuesday night and can be viewed by clicking here outlined some of the difficulties faced by soldiers and their families in brain trauma rehabilitation programs.

Part two of the story which airs tonight will focus on the consequences of undiagnosed traumatic brain injury.   

New Study Shows Bicycle Helmets Prevent Head and Brain Injuries

According to a report to be presented tomorrow at the annual meeting of the American Association of Neurological Surgeons in San Francisco, experiments conducted with water filled human skulls confirm that bicycle helmets that meet U.S. standards do protect children from head injury and brain damage.

An estimated half a million Americans seek emergency room treatment each year for bicycle related injuries.  Head injury accounts for approximately 69,500 of these visits.  Each year approximately 600 people die in bicycle related accidents, with two thirds of them dying from head injury.

Remember the best cure for a brain injury is prevention.  Set the right example and wear a helmet yourself!

More infomation on bicycle helmet safety can be obtained at the bicycle helmet safety institute .

You can read more information about this study by clicking here .

Medical Malpractice: USA Today Editorial

From time to time, I am asked to look into cases of brain injury caused by medical malpractice.  The rights of those who have been injured by medical malpractice and hospital malpractice are in extreme jeopardy by the Republican majority in Congress trying to restict patient rights.

The following is an editorial published on April 20, 2006 in USA Today that deserves reading by all involved in the malpractice debate:

"Whose side are they on?

The thought of a surgeon taking a scalpel to the wrong limb, organ or patient sends chills down the spine of anyone who has been in a hospital.
Eighty-four cases of what's known in the business as "wrong-site surgery" were reported in the USA last year. But that's just the "tip of the iceberg," because many hospitals across the country aren't obligated to account for such blunders publicly, says Dennis O'Leary, who heads a group that inspects health care facilities.

The chances of wrong-site surgery are slim — about one in 113,000 operations, a study published Tuesday in Archives of Surgery notes. Still, any incident is unacceptable. In one typical case, instead of removing a benign tumor from Doug McCoy's right ear last September, surgeons at Maricopa Medical Center in Phoenix operated on his left ear — which had no tumor.

In an effort to eliminate such blunders, surgeons have been required since 2004 to mark the spot they plan to cut while consulting with their patient before the operation. Nurses are supposed to call a "time out" in the operating room to conduct a final safety check to ensure that the right procedure is performed on the right patient.

So why do these catastrophic mistakes keep happening? Mainly because systems designed to prevent errors are faulty, or not followed, researchers say.

Some surgeons who think they'd never make such a stupid mistake often ignore safety protocols. Stubborn resistance to standardized conduct is part of the culture of medicine.

Airline pilots overcame this barrier long ago. Even the most experienced pilots must run through a checklist before taking off. It may be embarrassing for surgeons to be asked if they know for sure which side — or patient — they're about to operate on. But it's a lot less embarrassing than making a grievous error. Swallowing a little pride may save a limb, or a life.

Hazards in hospitals. Surgical screw-ups are a small part of a much larger patient-safety problem in hospitals.

Incidents such as bedsores, post-operative infections and failure to diagnose and treat conditions that develop in the hospital continued to plague American hospitals, according to a new study of Medicare patients by HealthGrades, a health care ratings company.

The study found that 1.24 million patient safety incidents occurred in nearly 40 million hospitalizations from 2002 to 2004. Those incidents were associated with 250,000 potentially preventable deaths and $9.3 billion of excess costs. For the second straight year, incidents increased slightly.

What can be done? Only 23 states have mandatory error-reporting systems, and standards of measurement aren't consistent. More states need to adopt rigorous reporting systems, and they should publicly release the type and number of patient safety incidents at each hospital. Exposure can spur progress.

That's what Minnesota has done, and it's ranked as the nation's top state for improving patient safety. A unique program there allows fiercely competitive hospitals to work together to share data, highlight best practices and implement tested solutions. As a result, Medicare patients in Minnesota had a nearly 30% lower risk of a safety incident compared with New Jersey, listed as the worst state.

Progress in reducing medical errors has been painfully slow. Speeding improvements requires making safety a top priority, publicly identifying hospitals that miss the grade and rewarding those that exceed it."

Thanks to the Greedy Trial Lawyer blog for a heads up on this editorial.

Consensus Conference on Coma and Impairments of Consciousness

I was privileged to address an important medical conference yesterday which is taking place this weekend in New York and is attempting to review information on coma recovery as well as recovery from other altered states of consciousness (persistent vegetative state and the minimally conscious person) and prepare a consensus statement.

The conference which is underwritten by the Northeast Center for Special Care who is co sponsoring the meeting along with the National Brain Injury Research, Treatment and Training Foundation and the International Brain Injury Association has brought together leading researchers, clinicians and policy makers in the field of coma recovery to discuss the wide ranging issues of patient care, long term prognosis, future research needs and proposed rehabilitation models.

My message to this prestigious group was that the  mission of the Brain Injury Association of New York was not only to improve the quality of life for persons with a brain injury but that it also included improving the quality of life for family members and friends following a brain injury. In discussing long term outcomes and care of persons with significant brain injury such as coma, persistent vegetative states or minimal consciousness, the family must also be taken into account with their own unique needs and care requirements. The emotional,  informational, financial and other needs of family members must always be taken into account and addressed in any discussion of these conditions. In addition to the needs of compassion and information presented in an honest, timely and intelligible manner, the family must be consulted and become an important partner in all decisions including long term placement and community placement options.  The new role of the spouse and child as a care giver must be addressed. Frequently heard comments after a return to consciousness such as "I feel like I am married to a different person or "I feel more like a mother than a spouse" must be confronted and responded to with appropriate assistance, information and support.

Brain Injury involves the entire family.  I was pleased to see that all of the participants agreed that the needs of the patient as well as their family were of primary importance.

I look forward to receiving and reviewing the consensus conference report and participating with this group in future discussions.

You can read the full press release which further describes the goals of this impairments in consciousness consensus conference by clicking here.

    

Latest Brain Injury Statistics

If we need any more proof regarding the silent epidemic of brain injury, the latest issue of the Journal of the American Medical Association (JAMA) contains the most recent statistics on traumatic brain injury released by the Centers for Disease Control.

As expected, Brain Injury continues to be a significant cause of hospitalization in this country with over 74,000 hospitalizations a year caused by brain trauma and head injury. Noteworthy is that the statistics compiled by CDC do not include emergency room visits with no hospital admission.  You can just imagine the extent of the problem if these statistics were included as well as those with mild injury that never even are seen in the emergency room.

The CDC further estimates that 1.4 million persons sustain a traumatic brain injury each year resulting in 80,000 to 90,000 individuals experiencing the onset of long term disability.

Out of the 74,000 plus persons hospitalized the leading causes of head and brain injury were unintentional falls, motor vehicle traffic incidents, and assaults.

In terms of age group, persons aged 75 years had the highest TBI-related hospitalization rate (264.4 per 100,000 population), at least twice the rate for any other age group; persons aged 15-24 years had the next-highest rate (103.3). Persons aged 75 years also had the highest TBI-related hospitalization rate associated with unintentional falls (203.9 per 100,000 population), at least three times the rate for any other age group.

The rates of TBI-related hospitalization associated with motor vehicle accidents were highest among persons aged 15-24 years, 25-34 years, and 75 years; for each sex, the rate for persons aged 15-24 years was approximately twice the rate for any other age group.

Overall and in most states, the rate of TBI-related hospitalizations for males was approximately twice that for females. Among males, rates of TBI-related hospitalization associated with assault were highest in persons aged 15-24 years, 25-34 years, and 35-64 years; rates for males in each of these age groups were at least six times as high as those for females. Among females, rates of TBI-related hospitalization associated with assault were highest among those aged 0-4 years; females in this age group had approximately twice the rate as females in any other age group.

As troubling as the statistics are concerning the incidence of brain trauma, the statistics on the failure of the health care system to provide follow up care following discharge are even more alarming to me. 

For all injury categories combined, 66% of patients were discharged without subsequent health-care assistance, 17% were discharged home with health services (e.g., outpatient rehabilitation) or to residential and rehabilitation facilities, 3% percent were discharged to an acute care hospital, and 1% left against medical advice. Approximately 6% of patients had no definitive coded discharge disposition, and 6% of patients died while hospitalized.

The percentage of patients discharged without health-care assistance decreased with age, from 91% for persons aged 0-4 years to 32% for those aged 75 years. In contrast, the percentage of patients discharged to a residential facility increased with age, from 1% for persons aged 0-4 years to 31% for those aged 75 years, as did the percentage of those who died in the hospital (from 3% for persons aged 0-4 years to 13% for those aged 75 years).

Stduents With Traumatic Brain Injury: Behavavior Assessment and Problem Solving

Behavior issues following brain damage presents a great deal of challenges to the school system.  Unfortunately, most educators have not received any training in how to recognize and deal with the issues following the return to school after a traumatic brain injury (TBI).  Children are frequently mislabeled and do not receive the services they so desperately deserve. 

A new TBI Web cast: "Behavior Assessment and Problem Solving Using Positive Behavior Supports for Students with Traumatic Brain Injury," sponsored by the National Association of Head Injury Administrators and the United States Department of Health and Human Services, Maternal Health Project has been announced.

The Web cast will take place Thursday, April 27, 2006, from 2:00pm to 3:30pm EDT, and it is easy to register!  To register for the event, click here.   

If you are a parent with a child who has sustained a brain injury or brain damage, I encourage you to join this event AND inform your school (special education department and classroom teachers) so that they can participate as well.

The Web cast takes place entirely online and REQUIRES PRIOR online registration to ensure that your computer meets all technical requirements.  Be sure to use the same computer to view the Web cast that you used to register.

This Web cast will be useful as a training resource for a wide variety of educators, school nurses and other school staff working with students who have traumatic brain injury.

The scheduled presenter is Linda R. Wilkerson, MS.Ed. She works with the Kansas Neurologic Disabilities Support Project, and has presented similar material that has been received enthusiastically by educators.  Her presentation will enable participants to understand why it is important to correctly identify students with TBI and provide them with appropriate supports and services.  Participants will be able to construct positive plans to deal with problem behaviors.  The Web cast also provides ways to identify potential behavior problem "triggers" for students following a TBI and develop positive interventions to proactively deal with students to avoid classroom disruption.  The main presentation will be followed by a question and answer session.

For anyone who can't be present for the 4/27 Web cast premiere, there will be an archived copy available about one week after the event by clicking here 

Increased Risk of Death Following Brain Damage

A study in the Journal of Head Trauma Rehabilitation on the causes of death one year following a traumatic brain injury (TBI)  reported some very disturbing findings

The comprehensive study utilized data from the TBI Model Systems National Database, the Social Security Death Index, death certificates, and the US population age-race-gender-cause-specific mortality rates for 1994. It reports on two thousand one hundred forty individuals with TBI completing inpatient rehabilitation in 1 of 15 National Institute on Disability and Rehabilitation Research-funded TBI Model Systems of Care between 1988 and 2001, and surviving past 1 year post injury.

The study reported that individuals with TBI were about 37 times more likely to die of seizures, 12 times more likely to die of septicemia, 4 times more likely to die of pneumonia, and about 3 times more likely to die of other respiratory conditions (excluding pneumonia), digestive conditions, and all external causes of injury/poisoning than were individuals in the general population of similar age, gender and race.

The full study can be found at:  J Head Trauma Rehabil. 2006 Jan-Feb;21(1):22-33

Epilepsy and Seizure Disorders in Children: New Review Article

For those interested in epilepsy in children a comprehensive review article has been published in the April issue of Pediatric Clinics of North America ( 2006 Apr;53(2):257-77).    

Seizures are the most common pediatric neurologic disorder.  Four to ten percent of children suffer at least one seizure in the first 16 years of life  with may of these seizures resulting from a traumatic event or accident. Falls and car accidents are leading causes of head injury in children.  The incidence is highest in children less than 3 years of age, with a decreasing frequency in older children. This article describes the types, diagnoses, and management and disposition of this pediatric neurologic disorder.

Helmet Guide Issued By Consumer Product Safety Commission

Bicycle_picture_with_helmet The best cure for a head injury is prevention!

Spring is here and millions of Americans are heading outdoors to take part in their favorite sports activities. That means wearing a helmet each time you jump on a bike or skateboard, or put on your in-line skates.

The consumer product safety commission (CPSC) has released a new guide, “Which Helmet for Which Activity.” CPSC believes the guide will help consumers determine the best type of helmet for their activity and help to prevent head and brain injuries.

“Thousands of consumers could reduce the risk of serious head injury or death by wearing a helmet. It’s important to wear the appropriate helmet for your sport,” said the Chairman of the Consumer Product Safety Commision chairman,Chairman Stratton.

Not all helmets, however, are created equal. Different activities require different helmets, and there are helmets for every season’s sports. Each type of helmet is designed to protect your head from the impact that can take place in the particular sport for which it is intended. In a collision or fall, a helmet absorbs most of the impact energy, instead of your head.

Wearing a bicycle helmet while biking, for example, can reduce your risk of head injury by 85 percent, and reduce the risk of brain injury by 88 percent, according to a study published in the New England Journal of Medicine.

According to CPSC’s 2004 estimates, bicyclists received about 151,000 head injuries that were treated in U.S. hospital emergency rooms. Nearly 11,000 or 7 percent of those emergency room visits resulted in hospitalization.

Skateboarders visited hospital emergency rooms with about 18,000 head injuries, and approximately 760 or 4 percent were hospitalized. CPSC estimates horseback riders received about 14,000 emergency room-treated head injuries. Approximately 2,400 or 17 percent of those head injuries required hospitalization.

Many of these injuries could have been prevented through proper helmet usage.

Bicycle helmets manufactured after 1999 must comply with the CPSC bicycle helmet mandatory safety standard. The standard also requires that chin straps be strong enough to keep the helmet on the head and in the proper position during a fall or collision. Other helmets are subject to other safety standards.

A proper fit is as important as wearing the correct helmet in helping prevent head injuries. A helmet should be both comfortable and snug. Be sure that it is level on your head, not tilted back on the top of the head or pulled too low over the forehead. It should not move in any direction when adjusted properly. Make sure the chin strap is securely buckled so the helmet doesn’t move or fall off during a fall or collision.

CPSC’s “Which Helmet for Which Activity” guide is a free publication and can be ordered by calling CPSC’s Hotline at (800) 638-2772. An on-line version of the guide (pdf) can be found  by clicking here .