Heading off disability

Trauma: A new form of treatment for brain injury improves the likelihood that patients will be able to resume normal life.

March 25, 2001|By Linda Marsa, | Linda Marsa,,LOS ANGELES TIMES

It was a typical mother-daughter disagreement -- until things went dreadfully wrong. Medrith Filley and her 15-year-old daughter, Heather, were having a heated discussion as they pulled up to their home in Mission Viejo, Calif., one Saturday morning in November 1997. Heather suddenly decided to jump out of the car, and the heel of her shoe caught on the doorjamb, flipping her backward, her head hitting the pavement hard.

Filley, a nurse, knew immediately that her daughter's injuries were grave -- her teeth were clenched, a symptom of profound brain injury, and she wasn't breathing. Heather lapsed into a deep coma after she was rushed to a local hospital. When surgeons operated on her, they discovered blood clots everywhere, and just about every part of her brain had sustained serious damage.

But instead of pumping her up with steroids and diuretics to dehydrate her and thus reduce swelling in the brain, which was the traditional method for treating head injuries, Heather's doctors followed a new protocol. She was tethered to monitors that measured blood pressure in her brain and blood-oxygen saturation, while catheters siphoned off excess fluids. Surgeons removed a large part of her skull to ease the pressure from the brain's swelling. All of this was designed to keep her blood pressure high enough to maintain a normal blood flow and to ensure her brain got the oxygen and fuel it needed to heal.

Her condition was touch-and-go for weeks, but gradually she recovered and was well enough to go home. She was in intensive rehabilitation for months and wore a helmet for six months to protect her exposed brain until it healed enough for her skull to be reassembled.

Heather, who's now a vibrant, college-bound high school senior, was incredibly lucky. It was pure chance that Mission Hospital Regional Medical Center, which had just begun a new program for treating brain injuries, was the closest trauma center to her home. This novel therapeutic approach, authorities say, can mean the difference between life and death, or between resuming normal activities and a lifetime of dependency.

There's nothing miraculous about Heather Filley's remarkable recovery. "It's just good science, and the technology that saved her should be routine," insists Dr. Jamshid Ghajar, a neurosurgeon at Cornell Medical College and president of the Brain Trauma Foundation, a nonprofit educational organization in New York. Unfortunately, it's not. Despite striking gains made by hospitals that have adopted these new brain-injury standards, most U.S. hospitals don't follow this course of treatment.

Little wonder that the rates of death and severe disability among brain-trauma victims remain stubbornly high. Each year 230,000 Americans are hospitalized with brain injuries from car accidents, falls and assaults, leading to death or serious impairment in more than half the cases. In fact, more than 5.3 million Americans live with a disability as a result of a traumatic brain injury.

Yet people such as Heather Filley don't have to be doomed to life in a coma or having a permanent disability. Recent studies have shown that the traditionally high rates of death and irreversible brain damage can be drastically cut by implementing the simple procedures doctors used on Heather: monitoring the pressure inside the brains of victims, and maintaining blood flow to make sure tissue is supplied with vital nutrients and oxygen.

"We're in the midst of a vast paradigm shift in the treatment of head injury," explains Sylvain Palmer, a neurosurgeon and chief of staff at Mission Hospital.

The numbers tell some of the story. In the three years since Mission Hospital established its program, results have improved dramatically. The number of patients with traumatic brain injuries who are able to function normally nearly tripled, death rates plummeted by almost two-thirds and the number of victims who were severely disabled or in a persistent vegetative state was reduced by half. Other U.S. hospitals with comparable brain-injury programs report similar results.

However, a survey done last year by the Brain Trauma Foundation revealed that only about one-third of the approximately 500 U.S. hospitals that treat traumatic brain injuries are using some of these techniques, and fewer than one in five use all of them.

("Shock Trauma was one of the earliest, if not the first, trauma center in the country," says Dr. Robert R. Bass, executive director of the Maryland Institute for Emergency Medical Service Systems. As a result, he explains, advanced techniques for dealing with brain injury have been in place in Maryland for some time. "We're doing some cutting edge research in terms of measuring pressures in the brain." Protocols for treating brain injuries, Bass adds, have been established on a statewide basis.)

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