Emergency Medicine leads in latest national traumatic brain injury guidelines

A national team of 22 medical experts, including senior author Ben Bobrow, MD, FACEP, professor and John P. and Kathrine G. McGovern Distinguished Chair in the Department of Emergency Medicine, has published in Taylor & Francis the third edition of the Brain Trauma Foundation’s Prehospital Guidelines for the Management of Traumatic Brain Injury.

The practice guidelines revision, developed by a multi-disciplinary group of leaders in the field, went through an extensive peer review process by national professional organizations. The guidelines present the best available scientific evidence to support clinical decision-making in the prehospital setting, when TBI care can have the most significant impact on outcomes. They also establish a research agenda for future investigations into this major public health problem.

TBI is a leading cause of death and disability for both children and adults, and outcomes are profoundly linked to the timing and quality of care provided before patients reach the hospital. There were more than 64,000 TBI-related deaths in 2020, and more than 5 million people live with TBI-related disability in the US.¹

“Death from severe TBI often occurs within the first few hours following injury,” the authors said. “Prehospital and early management of the primary injury with prevention of secondary brain injury and avoidance of secondary treatment-induced brain insults are critical to optimizing outcomes.”

Continuous cerebral blood flow is paramount, and even brief episodes of systemic hypotension, hypoxia, or inadvertent, treatment-induced hyperventilation are strongly associated with poor outcomes in both children and adults. ²

We are extremely excited to help publish and disseminate these new TBI guidelines and to be part of the TBI research team leading new discoveries culminating in these lifesaving guidelines,” said Bobrow. “From our previous NIH-funded EPIC trial, we know that implementing these guidelines can triple the likelihood that a person with a severe TBI will have a good outcome. That equates to the potential for thousands of children and young adults across the country going back home with their families every year after they sustain a TBI.”

Prehospital providers must rapidly recognize and seamlessly manage TBI patients and transport them to the most appropriate receiving facility. Prognosis in TBI results not only from the initial or primary injury, but also from secondary injury and inadvertent, treatment-induced insults that occur subsequent to the event, such as further injury from brain swelling. The guidelines revision addresses key actions EMTs and paramedics should take to prevent, rapidly identify, and minimize all secondary brain injuries and thus maximize survival for TBI patients. The guideline revision comes as EMS systems dramatically improve survival and neurologic outcomes after cardiac arrest, ST Elevation Myocardial Infarction (heart attack), acute stroke, and other time-sensitive conditions. Such improvements are possible in TBI but, as with all acute medical conditions, the risks and benefits associated with prehospital interventions must be appraised critically and continuously.

To read the guidelines established in the paper, click here.

¹ Centers for Disease Control and Prevention. National Center for Health Statistics: Mortality Data on CDC WONDER. Accessed 2022, https://wonder.cdc.gov/mcd.html.

² Al Lulla, Angela Lumba-Brown, Annette M. Totten, Patrick J. Maher, Neeraj Badjatia, Randy Bell, Christina T. J. Donayri, Mary E. Fallat, Gregory W. J. Hawryluk, Scott A. Goldberg, Halim M. A. Hennes, Steven P. Ignell, Jamshid Ghajar, Brian P. Krzyzaniak, E. Brooke Lerner, Daniel Nishijima, Charles Schleien, Stacy Shackelford, Erik Swartz, David W. Wright, Rachel Zhang, Andy Jagoda & Bentley J. Bobrow (2023) Prehospital Guidelines for the Management of Traumatic Brain Injury – 3rd Edition, Prehospital Emergency Care, DOI: 10.1080/10903127.2023.2187905

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