INTERVIEW HIGHLIGHTS:
Why are there so many traumatic brain injuries each year?
There's a wide spectrum of brain injuries from mild to severe, and they can occur from a lot of different things.
Classically, we would see brain injuries with very bad car accidents, but as the population ages and becomes sicker at baseline and takes more and more medications, including blood-thinning medications, we are seeing more and more traumas related to relatively minor incidents like ground-level falls or falls from very low heights.
Degrees of traumatic brain injury
It basically breaks down into three levels: mild, moderate, and severe.
We classify that based on how the patient interacts with us when they get to the hospital. Are they opening their eyes? Are they talking? If so, are they talking appropriately?
And then most importantly, how are they moving? Are they moving their arms or their legs? What's their level of consciousness?
Can you have a mild traumatic brain injury and not know it?
Absolutely. We see a significant number of either mild traumatic brain injuries or concussions in the emergency room and in the trauma bay, and they may even have a normal head CT and their injury may manifest in a delayed fashion with very mild symptoms like headache, blurry vision, nausea, vomiting, irritability, even impulsivity.
Family members say some patients are not the person they were before such and such happened.
So yes, you can definitely sustain an injury and either not pick up on it yourself or it may present in a delayed fashion.
Does treatment depend upon the severity of it?
It does. The patients are evaluated on arrival both clinically and radiographically with a variety of scans and then based on the severity of the injury. We decide if they can be managed safely without a procedure or operation, or if they do require some type of procedure or operation.
Fortunately, only about 10 to 20 percent of brain injuries and 20 to 30 percent of spinal injuries go on to need some type of invasive operation.
For those that don't, they're monitored very closely in specialized units with specialized nurses, and they get follow-up imaging as needed.
And of course, if they do go on to need an operation, then that specific intervention is tailored to the individual patient and their individual injury.
Has treatment changed greatly over the years?
A lot of the tenants are still the same: blood pressure management, and close monitoring in the ICU.
But our abilities to detect and treat brain swelling have improved significantly. Our ability to pick up the more minor or mild injuries has improved significantly. And so, yes, it definitely has changed over time. And, of course, what we can do in the operating room has improved substantially.
What can the average person do to prevent traumatic brain injury?
Everything we do here is reactionary.
Patients can do a lot to help themselves, and they're common-sense things:
- Put your seatbelt on.
- If you have to ride a motorcycle or you're riding a bike, wear a helmet, wear protective gear. Hopefully, that prevents you from ever needing to meet me or any of my colleagues.
RESOURCES:
CDC: Traumatic Brain Injury & Concussion
Mayo Clinic: Traumatic brain jury
NIH: Traumatic Brain Injury Information Page
Interview highlights were lightly edited for clarity.
Got a tip? Email Sam Baker at sbaker@kera.org. You can follow Sam on Twitter @srbkera.
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