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Lack of medical follow-up in head injuries a ‘massive public health epidemic,’ researcher says

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Lack of medical follow-up in head injuries a ‘massive public health epidemic,’ researcher says

Every year, millions of Americans walk through emergency room doors to seek treatment for a traumatic brain injury. For many patients, that’s the last time they receive help.

Fewer than half of patients who received treatment for a head injury were given follow-up care including educational materials about their condition or secondary appointments, according to a study published Friday in JAMA Network Open by 65 scientists from across the United States.

David Okonkwo, clinical director of the Brain Trauma Research Center of the University of Pittsburgh, said the lack of follow-up care and education involving minor traumatic brain injuries (mTBIs) is a “massive public health epidemic.”

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“One of the goals of this study is to better understand the public health implications and identify gaps in clinical care so we can do a better job of treating patients.

“This study should be a siren call to the National Institutes of Health and other federal agencies about the tremendous gap between the public health need and the public health resources that are devoted,” said Dr. Okonkwo, also the director of the Neurotrauma Clinical Trials Center at UPMC Presbyterian.

The study was based on data from Track-TBI, an ongoing national study concerning treatment of individuals with head injuries. It’s the first published study using Track-TBI data to focus on how the lack of health resources affects those with traumatic brain injuries, Dr. Okonkwo said. 

Conducted between February 2014 and August 2016, the study involved 831 patients, 17 and older, with head injuries in one of 11 participating trauma centers. Eligible patients underwent a CT scan within 24 hours of injury and scored between 13-15 on the Glasgow Coma Scale. That scale describes the level of consciousness of a head-trauma victim, with a grade of 3 involving deep unconsciousness and 15 being least severe.

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The individuals were followed for a year after the initial ER visit and completed surveys two weeks and three months after the injury occurred, Dr. Okonkwo said. The survey included questions concerning symptoms, follow-up care and whether they had been educated about their condition.

Of the sample, fewer than half self-reported receiving follow-up care: 42 percent reported receiving education material at discharge and 44 percent reported receiving follow-up calls from hospitals or a follow-up appointment three months after the injury.

Notably, of the patients who experienced from three or more moderate to severe post-concussive symptoms, only 52 percent reported having a follow-up appointment within three months after the injury occurred. Even in the 236 patients who were found to have a lesion — a sign of a serious brain injury — 40 percent did not receive follow-up care three months after the injury.

“One of the most surprising finds of the study is that less than half of people were offered a follow-up appointment following their hospitalization for a traumatic brain injury,” Dr. Okonkwo said.

The study’s lead author Seth Seabury, director of the Keck-Schaeffer Initiative for Population Health Policy at University of Southern California, said patients often are released early because the mortality risk of minor head injuries is low.

The study, a comprehensive analysis of mTBI victims, also considers economic and social impacts that a brain injury can have on a patient.  “Part of the goal isn’t just looking at clinical symptoms but asking if they go back to work, asking if they work the same hours,” said Mr. Seabury, who holds a Ph.D. in economics.

Within six months, roughly two thirds of patients reported that they had not returned to work full time without symptoms — such as migraines, cognitive issues, vision loss, memory loss.

Study results showed that providers can lack consistent post-injury care, leading to uncertainty in treatment, despite the numbers of TBIs that occur. If this lack of follow-up care occurred with any other medical condition — diabetes, heart disease, etc. — it would be considered medical malpractice, Mr. Seabury said.

Brain injuries have been in the national discussion lately particularly concerning professional athletes and military personnel. 

Michael Collins, clinical and executive director of the UPMC Sports Medicine Concussion Program, was not involved with the study but has worked with Dr. Okonkwo on previous projects. He found the study revealing with hopes it will be a call to action for clinicians.

The study had “well done methodology” and represented the fact that kids aren’t getting the care that they need, said Mr. Collins, who holds a Ph.D. in clinical psychology. Not getting adequate follow-up care could lead to various health problems including death. But, he said, he expects outcomes to improve with increased awareness.

Pittsburgh medical centers, including UPMC Sports Medicine, Rehabilitation Medicine and Neurosurgery divisions have been ahead of the curve in severe head injuries for years, Dr. Okonkwo said.

“This study opens the door to a much stronger conversation about how to have the quality of care in the Pittsburgh region spread to other areas of the United States,” he said.

Marie Fazio: mfazio@post-gazette.com, 412-263-1458. 

 

First Published: May 25, 2018, 3:04 p.m.

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