Each year in the United States, nearly 5 million adults and children seek medical care for a traumatic brain injury.
Now after more than half a century, based on a mountain of data, and a team of international experts, a new proposal published in Lancet Neurology sets forth a new framework to overhaul how to more precisely assess the injuries, and to do a better job in caring for the patients.
Corresponding author for the new criteria is Dr. Geoff Manley. Manley is chief of neurosurgery at Zuckerberg General Hospital and a professor of neurosurgery at UC San Francisco. He is also a member of the UCSF Weill Institute for Neurosciences.
Manley said the current clinical guidelines are not very precise.
For years, trauma centers have used what’s called the Glasgow Coma Scale to assess patients. Typically, and generally speaking, the measurement devices patients into three categories of TBIs: mild, moderate, or severe, and the patients are then treated accordingly, and that’s a problem according to Manley. He explained how some patients categorized as having ‘severe” TBI are often approached with a bias in prognosis, and the families are guided to consider withdrawing life support. Some of these patients have recovered and gone on to live full lives. He added on the other side of the spectrum, some patients diagnosed with “mild” TBIs, or a concussion are often just disregarded and sent home to recover.
“And we know from studies that we’ve done over the last 10 to 15 years, that a number of people with so-called mild TBA actually they’re not mild at all,” said the neurologist.
A case in point: Sean Sanford of San Francisco. Sanford writes fiction and music reviews, is a substitute teacher, and is currently getting his master’s in creative writing.
He also really loves skateboarding. 8 years ago, he was about to show his good friends a new trick, but he slipped, fell, and hit his head on a concrete ledge.
Sean was knocked unconscious. When he came to, he saw his friends and his wife Candice standing over him asking him if he recognized any of them.
“I kept repeating myself and being like what are we don’t like where are we? What’s going on?” Sanford recounted.
His friends brought him to Zuckerberg Emergency. Clinicians used the Glasgow Coma Scale and assessed Sean with a bad concussion. Sean told CBS News Bay Area that he would be released, and that the concussion should be able to resolve with rest and time.
But Sanford told us the ER team decided, that before they are releasing him, that they would scan his brain. The next thing he knew, he was wheeled into surgery.
“They sent me into a surgery room, they called Dr. Manley who wasn’t working that day. They called him in and they said we’ve got a patient who’s cracked his skull and its bad and if he doesn’t get treatment right now, he’s going to die,” remembered Sanford
Dr. Manley told CBS News Bay Area how SF General follows advanced protocols, but that he would like to provide the benefits and treatments to other trauma centers, especially those located in rural areas, and the patients they serve better tools and more precise chance of a proper assessment. Some patients with mild or moderate TBIs often develop symptoms long after they are dismissed from the hospital, and without follow-up or care, they go on to live debilitating lives.Â
An international coalition of experts and patients came up with the criteria. Manley is one of the corresponding authors. The new framework will soon be phased in at trauma centers across the U.S. on a volunteer basis.
The new criteria involve what Manley and the report called the “4 pillars”: a clinical exam, biomarker blood tests which can show levels of tissue damage, imaging needed by patients who show certain levels of tissue damage, and then “modifiers” that include a patient’s age, gender, mental health, support system, and even prior head injuries.
“We know that it’s not just what the injury brings to the patient but what the patient brings to the injury,” explained Manley on the inclusion of “modifiers”.
As for Sanford, he needed follow-up care. After the accident, he developed epilepsy and depression. He is getting better, but it’s a very slow process. Sanford now meditates and at the family store on Divisadero, helps his wife develop handmade products that promote relaxation.
“It’s really a place of magic and a place of healing,” noted the writer.
He still skateboards, but now, always with a helmet.
