CINCINNATI—As the weather warms and recreation and travel increase, a Cincinnati specialist in neurocritical care urges people of all ages to protect themselves from the risk of brain and spinal cord injury by always planning for the unexpected.
“More than 1.5 million recognized brain injuries occur in this country every year,” says Lori Shutter, MD, associate professor of neurosurgery at the University of Cincinnati (UC) and director of neurocritical care at the Neuroscience Institute at UC and University Hospital. “But the risk of neurotrauma remains vastly underappreciated by the general public.”
Human nature, Shutter continues, prevents people from imagining the worst. “People think, ‘I’m going to drive safely. I’m a safe driver. I don’t break the speed limit.’ But maybe it’s not you who causes the accident—it’s the person in the semi who hasn’t slept for 30 hours, reaches out to get his cell phone and swerves into your lane. It is the person who went to the bar, drank six beers, then decided to drive home and runs a red light. So people need to understand that although they may be safe, it’s the unexpected that can destroy their lives. By putting on your seatbelt, by putting on your helmet, you’re planning for the unexpected. And that’s what really makes you safe.”
Statistics show that University Hospital, which has the only adult level-I trauma center providing specialized care for 2.4 million Tristate residents, sees an escalation of trauma cases during warm-weather months.
A majority of these injuries could be prevented, Shutter says, if people planned for the unexpected by always:
- Wearing a seatbelt;
- Seating children under 12 in the back seat of a vehicle with age-appropriate restraints;
- Wearing a helmet when cycling, rollerblading or traveling by motorcycle;
- Arranging for a designated driver if you are out and plan to consume alcohol;
- Entering an above-ground swimming pool or unfamiliar body of water feet first;
- Instructing children not to touch or play with firearms.
The mortality rate for patients who suffer traumatic brain injury has fallen from 50 percent in the 1980s to 30 percent in recent years, Shutter says. But those who survive may experience physical or cognitive loss and disability ranging from mild to profound.
Healing a damaged brain or spinal cord is more complex than people realize, says Shutter, who is also a specialist with the Mayfield Clinic. “It’s not like putting bones back into place. The brain and spinal cord are a collection of millions of little wires that all have slightly different jobs, and they all have to work together at the same time.”
A patient with a significant neurological injury is typically transported to a level-1 trauma center, where a neurosurgeon is present or on call. Brain-injured patients are assessed and given a score from 3 to 15 on the Glasgow Coma Scale, an objective measurement of consciousness.
The initial injury is followed by brain swelling and a wave of secondary, molecular-level injury, making the first week of treatment critical, Shutter says. “You need to be aggressive at the start and remain so during the first week. Then you can step back and re-evaluate the patient’s potential for recovery. At that time you may have deep discussions with the family about quality-of-life issues. But you shouldn’t have those discussions in the first few days, because you don’t know at that point how the patient will respond to treatment.
“Because 80 percent of patients who are admitted with a very low coma rating of 3 or 4 are likely to do poorly, many hospitals may not treat aggressively,” Shutter continues. “But at University Hospital, because we know that you cannot reliably predict which one out of five patients with that coma rating will have a favorable outcome, we go all out for everyone.”
Researchers are continually developing new technologies and therapies to maximize patient outcomes. At University Hospital these include:
- Research regarding chemicals in the brain that may affect recovery;
- New technology that provides continuous monitoring of oxygen levels and blood-flow in the brain;
- Diagnosis and management of seizures that occur after brain injury;
- A portable CT scanner that enables technicians to scan the patient in the neuroscience intensive care unit. A study published in 2000 showed that scanning a patient in the ICU results in significantly fewer complications than transporting the patient for scanning elsewhere in the hospital.
The Neuroscience Institute, a regional center of excellence, is dedicated to patient care, research, education, and the development of new treatments for stroke, brain and spinal tumors, epilepsy, traumatic brain and spinal injury, multiple sclerosis, Alzheimer’s disease, Parkinson’s disease, disorders of the senses (swallowing, voice, hearing, pain, taste and smell), and psychiatric conditions (bipolar disorder, schizophrenia and depression).