Traumatic Brain Injury (TBI) Treatment Guidelines Do Not Effect Outcomes: Study

The findings of new research suggest that treatment guidelines for traumatic brain injuries (TBI) may have no impact on the overall outcome or survival rates for patients. 

In a study published last week by the medical journal JAMA Surgery, researchers indicate that patients who were treated at hospitals that follow the recommended Brain Trauma Foundation (BTF) guidelines were no better off.

A traumatic brain injury (TBI) can result from a severe blow to the head, causing loss of consciousness, skull fracture, internal bleeding or a combination of the three.

The Brain Trauma Foundation has issued guidelines for treating patients who have suffered a TBI, recommending that hospitals monitor intracranial pressure, blood pressure, oxygenation, administering antibiotics and use compression stockings. After the BTF guidelines were first published in the early 1990s, reports suggested that many hospitals saw a 50% decreased in the severe TBI death rate.

In this new study, researchers focused on 14 hospitals within Los Angeles County that followed the Brain Trauma Foundation (BTF) guidelines. Two items were monitored for compliance; patient craniotomies and intracranial pressure (ICP) monitoring.

The research team, lead by Dr. Aaron Dawes, from the University of California, Los Angles, found that there was a wide variance in compliance with guidelines among the hospitals in the study, ranging from 6.7% to 76% for craniotomies and 9.6% to 65 % for ICP monitoring.

Overall, there was no association between compliance rates and better outcomes or lowered death rates. Death rates varied widely among the hospitals, however other research has shown survivors of traumatic brain injury are three times more likely to face a premature death.

The findings have drawn criticism from proponents of the brain injury treatment guidelines, with some indicating that the largest group of patients included the study suffered ground level falls, and nearly 17% of patients had a loss of gray-white-matter differentiation. Critics say these patients should not be included in the study and many would have died regardless of their treatment, skewing study results. About 35% of patients in the study fit in this category.

Other criticisms include researchers not examining other important guidelines, which may have shown better evidence of how it effects mortality.

Researchers say the study highlights a need to determine what should be done to improve low performing hospitals and whether they should receive patients with TBIs.

Critics warn that the study should not be taken out of context. Many say guideline compliance should not be used as a measure of hospital quality and that it doesn’t tell enough about the differences in hospitals and how they practice.

Other research has also revealed some treatments to be unhelpful in treating TBI, including hyperbaric oxygen therapy, which proved to be no more than a placebo effect.

Other studies have shown some promise in treating TBI. Research published last year showed promising results concluding traumatic brain injury may be effectively treated by vacuum pressure. The application of vacuum pressure helped to limit tissue damage after a TBI.