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The Daily Wildcat

The Daily Wildcat


UA researchers reset the standards for how hospitals handle brain injuries

Drs. Peter Rhee and Bellal Joseph have saved the Banner – University Medical Center more than $4 million a year since the implementation of their new Brain Injury Guidelines in 2012.

At the majority of medical facilities across the nation, if a CT scan shows the slightest sign of bleeding in the brain a patient is sent to intensive care, scanned a second time and given neurosurgical consultation. Rhee and Joseph noticed that in minor cases this practice was a waste of hospital time and resources.

As a solution, Rhee and Joseph developed the Brain Injury Guidelines, which separate brain injuries into three categories to determine whether a repeat CT scan and neurosurgical consult are necessary. The first category consists of minor brain injuries, in which bleeding in the brain is less than 4 millimeters and the patient is conscious and responsive. The second category is a gray area in the Brain Injury Guidelines, which includes patients who show bleeding between 5 and 8 millimeters. The third category is for patients with very severe brain trauma, and CT scans showing more than 8 millimeters of blood.

Under these guidelines, people in the first category are often sent home. In the second they are kept and watched to see if another CT scan and surgical consult are necessary. In the third, which are severe cases, they are often given another scan and a consult.

The Brain Injury Guidelines have reduced repeat CT scans by 38 percent.

“The Brain Injury Guidelines is [a] way that makes the current process cheaper and more efficient,” Rhee said.

These new guidelines are not without opposition. Some neurosurgeons feel that implementing them is not totally safe. They fear that a patient could be sent home prematurely and their injury could get worse. However, Rhee and Joseph have practiced their guidelines on over 5,000 patients with positive results.

“Doctors change at a snail’s pace,” Rhee said. “They’re very worried about getting sued.”

The Brain Injury Guidelines have shown great success at the Banner – University Medical Center.

“We’ve saved a number of patients from going to the intensive care unit, we’ve decreased the overall cost per patient for these injuries, we’ve reduced the number of neurosurgical consultations and we’ve decreased the number of CT scans over the years,” Joseph said.

Joseph put the cost-saving capabilities of these guidelines into perspective by explaining how other states, such as Alaska, will immediately transfer patients to specialists in other parts of the country if a patient shows any sign of a head bleed, which costs a higher amount of money and resources.

“Brain injuries are very serious. If the reasoning a patient [is] home is comprehensive enough, then I’m fine with it,” said Nathaniel Wahl, a philosophy junior.

Joseph recently received a research grant from Defense Advanced Research Projects and is working with DARPA on drones that can transport injured soldiers from the battlefield to a hospital. He is also working on a device that occludes blood flow to the arm, which sends signals to the brain to reduce the inflammation of a brain injury.

Follow Nicholas Johnson on Twitter.

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