BRAIN

rehabilitative perspective when it comes to the treatment of these patients. Treatment management is complex and should be systematic, beginning at the scene with timely transport. Early operative interventions are also key.

According to the World Journal of Emergency Surgery, critical trauma care is ever-improving, yet TBI-related mortality rates are rising compared to other causes of death. Managing the acute phase after a severe TBI with polytrauma represents a challenging situation for every trauma team member and often involves the ‘damage control’ approach to sustain life. The challenge with polytrauma and concomitant traumatic brain injury patients is making sure equal emphasis is placed on stabilizing life-sustaining systems and doing everything possible to minimize brain damage.

Polytrauma Could Worsen Brain Injury

Primary brain injury results from mechanical injury at the time of the trauma whereas secondary brain injury is caused by the physiologic responses to the initial injury. Post-trauma care, as it relates to traumatic brain injury, is focused on halting or minimizing bleeding or clotting in the brain, among other biochemical processes, all of which result in secondary brain injury. Because polytrauma patients may require multiple damage control procedures, there is a risk of not providing ample emphasis on brain care. In addition, the presence of hypotension (low blood pressure), hypoxia (low oxygen levels), and fever — all commonly found in polytrauma patients — have been shown to initiate secondary brain damage.

Trauma Neurosurgery

The trauma neurosurgeon plays a key role in being able to ensure optimal treatment of polytrauma and concomitant TBI patients while minimizing secondary brain damage. Although brain surgery is highly complex and specialized, how it helps TBI patients comes down to decompression. Known as a craniotomy, this surgery relieves pressure on the brain, in turn slowing secondary brain damage. Dating back to Hippocrates, who is documented to have suggested their use in treating TBI, craniotomy revolutionized neurosurgery.

Choosing The Best Trauma Center

The best facilities for polytrauma patients to receive care are level one trauma centers. According to the American Trauma Society, A level one trauma center is capable of providing total care for every aspect of injury from prevention through rehabilitation, including surgical intervention. Although a level one trauma center can provide comprehensive treatment to trauma victims, they are not always capable of providing what is known as Simultaneous Multisystem Surgery (SMS) — which allows for different surgical teams to work on a patient simultaneously — the key to optimally treating polytrauma patients with TBI.

For a level one trauma center to provide SMS they must be equipped with a hybrid-emergency room system

(HERS) where diagnostic procedures, such as CT scans, and damage control interventions, such as neurosurgery, can be performed simultaneously without patient transfer. Studies have shown that the HERS approach has been associated with a shorter time to initiate CT scanning, emergency surgery, and fewer unfavorable outcomes in polytrauma patients with and without TBI — ultimately resulting in higher – and more functional — survival rates.

While the ability to perform SMS seems to be straightforward and beneficial, very few centers in the United States are equipped with HERS and have trained staff to perform SMS in the context of TBI complicated by polytrauma. Other countries appear to be ahead of the curve in this area of trauma response. For example, not only are many of Japan’s trauma centers equipped with HERS, but they have also developed the Japanese Association for Hybrid Emergency Room Systems to specifically address the needs of specialized HERS trauma teams.

Factors To Consider For The Best Outcome

According to an article published in the National Library of Medicine, the occurrence of TBI in polytrauma patients increases mortality and reduces their quality of life. Studies have shown that the crucial factors for ensuring the best outcomes in these cases involve getting the most appropriate care as quickly as possible. Factors such as the speed in which ambulatory care is on scene and the patient being transported to a level one trauma center — when possible one equipped to administer SMS — can make substantial differences in a patient’s recovery.