Strong ED Physician Begins National Head-Trauma Registry
NIH Funds Prevention Program to Track Why, How Injuries Happen
Wednesday, January 09, 2002
In the winter, emergency room physicians typically see a spike in head injuries from sledding, skiing and snow boarding accidents. It's a major, cyclical public health problem that adds up to about 8,000 head injuries each year in Monroe County.
But a new surveillance program at Strong Memorial Hospital could lead to better prevention and perhaps become a nationwide model. Jeffrey Bazarian, M.D., assistant professor at the University of Rochester Medical Center, has received a $560,000 National Institutes of Health grant to start the nation's first Emergency Department-based traumatic brain injury registry.
The project involves collecting details about every head-injury patient that comes to the Strong Memorial Hospital ED. Trained interviewers will ask patients or their families questions such as: Exactly where did the injury happen? How? Was a sport involved? Was the patient intoxicated? Wearing a helmet or seatbelt? Furthermore, Bazarian will scrutinize medical data to evaluate emergency care such as which imaging tests were performed or what treatments administered. He also intends to call patients after their injury to track outcomes.
This level of information is currently missing from hospital charts across the United States, Bazarian says, because most institutions do not have the time, personnel or technology to collect it. Therefore, when the Centers for Disease Control or other public health agency wants to review data on head injuries, the records are too vague to make useful conclusions.
"If we really want to design a prevention program, we need to know everything that happened during each injury, in great detail," Bazarian says. "Only then would we be able to look for things like geographic clusters or other environmental conditions that contribute to head injuries."
Strong Hospital, as part of an academic medical center with an emphasis on research and prevention, is well positioned for this project. The Emergency Department already employs people who are specially trained to interview patients for possible enrollment in research studies. Strong is also plugged into a statewide electronically coded pre-hospital data system. This allows Emergency Medical Technicians to enter patient information into a computer system that ultimately becomes part of the patient's hospital chart.
Once Bazarian begins collecting the details of head injuries, he can begin scientifically testing hypotheses. For example, a preliminary study of emergency patients done by Bazarian shows that while men are most likely to suffer head injuries, women have worse outcomes. Ultimately, this research could help physicians decide if hormonal differences play a role in recovery, and if so, how diagnosis and treatment should change.
Bazarian was motivated by a family tragedy to research brain injuries. His father died in 1993 of a head injury after falling down a flight of stairs. And as an emergency room physician, he sees plenty of seasonal head injuries - in summer due to bicycles and scooters, in autumn from football and soccer, and from outdoor play in winter.
One goal of Bazarian's research is to reduce the disabilities from head injuries. Although many head injuries are concussions, which are relatively minor, about 50 percent of these patients still suffer from headaches and have difficulty concentrating for as long as three months, Bazarian says. A full 25 percent of patients with concussions will have significant disabilities for six months.
"Some people think there is such a thing as a mild concussion," adds Sandra M. Schneider, M.D., professor and chair, Department of Emergency Medicine at the UR Medical Center. "But what we are learning from Dr. Bazarian and others in this field is that even a mild head injury can have significant consequences at least for a while."
View a panel discussion in which Dr. Bazarian discusses brain injuries in depth.
"Prevention is the key," Bazarian says. "In addition, having a surveillance system in place will allow us to eventually test new medications or other treatments for head injuries."
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