For patients with a traumatic brain injury, the default standard of care has just been turned on its head by a group of researchers at the University of Washington working with colleagues at six hospitals in Bolivia and Ecuador.
In a study published in the New England Journal of Medicine, the researchers found that intracranial pressure monitoring – the standard of care for severe traumatic brain injury – showed no significant difference than a treatment based on imaging and clinical examination.
“Within this field, this is a game changer,” said Randall Chesnut, a UW Medicine neurosurgeon based at Harborview Medical Center in Seattle and principal investigator of the study. “We’ve been treating a number not a physiology.”
The study is the first international randomized controlled trial on traumatic brain injury the NIH has funded and is the first study of its type in Latin America.
In the trauma world, getting a patient’s intracranial pressure less than 20 mm (millimeters of mercury) was the bellwether for treatment, even if it meant taking off a patient’s skull.
Raised intracranial pressure means that both nervous system (neural) and blood vessel (vascular) tissues are being compressed and could result in permanent neurologic damage or death.
“We suspect that one major issue is that 20 is not a magic number and that patients require a more complicated method of treatment,” said Chesnut.
University of Washington