1 / 32

Traumatic Brain Injury A Multidisciplinary Approach

Traumatic Brain Injury A Multidisciplinary Approach. Oscar Guillamondegui, MD, MPH, FACS Trauma Medical Director Vanderbilt University Nashville, Tennessee. Conflicts of Interest. None. Traumatic Brain Injury. Why does a trauma surgeon care?. Traumatic Brain Injury.

abla
Télécharger la présentation

Traumatic Brain Injury A Multidisciplinary Approach

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Traumatic Brain InjuryA Multidisciplinary Approach Oscar Guillamondegui, MD, MPH, FACS Trauma Medical Director Vanderbilt University Nashville, Tennessee

  2. Conflicts of Interest • None

  3. Traumatic Brain Injury • Why does a trauma surgeon care?

  4. Traumatic Brain Injury • Why does a trauma surgeon care? • Not a neurosurgeon

  5. Traumatic Brain Injury • Why does a trauma surgeon care? • Not a neurosurgeon • Don’t do cognitive evaluations

  6. Traumatic Brain Injury • Why does a trauma surgeon care? • Not a neurosurgeon • Don’t do cognitive evaluations • Have no long-term memory

  7. Traumatic Brain Injury • Why does a trauma surgeon care? • Managers of trauma • Contract with community • MAJOR problem with no major stakeholder

  8. Traumatic Brain InjuryBackground • 1.4 million people sustain TBI annually • Does not include • non-diagnosed • military • sports-related • $56 billion direct/indirect costs • 50,000 die annually • Approximately 100,000 long-term disability CDC, Report to Congress TBI, 2003

  9. Traumatic Brain InjuryBackground Langlois JHTR 2006

  10. Traumatic Brain InjuryBackground Langlois JHTR 2006

  11. Traumatic Brain InjuryBackground Langlois JHTR 2006

  12. All Major Trauma

  13. All Major Trauma Yes TBI

  14. All Major Trauma ISS >15 No TBI ISS >15 Yes TBI ISS< 15 Yes TBI

  15. All Major Trauma Ongoing Cognitive Issues ISS >15 No TBI ISS >15 Yes TBI ISS< 15 Yes TBI Ongoing Mental Health Issues

  16. Traumatic Brain InjuryOverview • TBI affects all levels of society • Majority (75 to 90%) recover quickly • “Mild” = 90% • 10 to 25% have long-term deficit • The ‘Hidden’ TBI patient • Emotional distress Iverson, Current Opinions Psych, 2005 Cicerone, JHTR, 2004 Gordon, JHTR, 1998

  17. Traumatic Brain InjuryLong-term Outcomes • Wide range of functional issues • Cognitive changes • Memory • Reasoning • Language difficulties (communication/understanding) • Senses • Loss of hearing, taste, smell • Mental Health: • Depression • Anxiety • PTSD

  18. Traumatic Brain InjuryLong-term Outcomes

  19. Traumatic Brain InjuryLong-term Outcomes: Depression • Community: 10% • 8 - 10% • Trauma Ctr: 20% • 12- 20% • Rehab Ctr: 30% • 15 -50% • Tertiary Care: 35% • 16- 77% AHRQ 11-EHC017-EF Apr ‘11

  20. Traumatic Brain InjuryLong-term Outcomes: Associated Findings • Anxiety: • 31% v 77% • PTSD: • 11% v 37% • Any concommitant: • 8-93% AHRQ 11-EHC017-EF Apr ‘11

  21. Traumatic Brain InjuryCognitive Therapy • Minimal intervention improves outcome • Contact post-discharge 48 hrs • Follow-up at 5-7 days • Cognitive assessment performed • Coping strategies for common symptoms • Follow-up at 3 months • Control Group had increased PCS complaints at follow-up Ponsford 2002

  22. Traumatic Brain InjuryCognitive Therapy • Increased intervention improves outcome • RCT (small: 24 cases/27 controls) • Intensive intervention led to more rapid progress • Those with progress discharged sooner • Intensity of therapy had no ‘ceiling effect’ • Cost-effectiveness remains an issue Shiel, Clin Rehab 2001

  23. Multidisciplinary TBI Clinic • Team • Trauma Surgeon • Nurse Practitioner • Social worker • Speech Pathologist • Brain Injury Association of Tennessee • Program Manager • Trauma Survivor Network Peer Visitor

  24. Multidisciplinary TBI Clinic • Program • Identify patients with Intracranial Hemorrhage • Upon admission • Consult with Speech-Pathologist • Cognitive Assessment prior to discharge • Include RANCHO • GOAT, Digit Span (see form) • Head injury literature at discharge • Contact information

  25. Multidisciplinary TBI Clinic • Program- 3 month follow-up • No charge visit • Physical Exam • Follow-up on any issues related to trauma • Cognitive Evaluation • QoLIBRI survey • Mental Health Screening • HADS

  26. Multidisciplinary TBI Clinic • Program- 3 month follow-up • Peer group interaction • TSN involvement • Brain Injury Association of TN • Personalized information on referrals/resources • Jean Doster-TBI Foundation of TN

  27. The Team

  28. Multidisciplinary TBI Clinic

  29. Traumatic Brain InjuryWhat Next? • Radiologic Imaging • DTI • Others • Genome analysis • ‘At risk’ populations • Improved prevention methods • Not hurt = no sequelae

  30. Traumatic Brain InjuryA Multidisciplinary Approach Oscar Guillamondegui, MD, MPH, FACS Trauma Medical Director Vanderbilt University Nashville, Tennessee

More Related