Impact of Multi-Disciplinary Care and Clinical Coach Coordinators on Participant Satisfaction and Retention in TBI Clinical Trials: A TEAM-TBI Study.

BACKGROUND: Targeted Evaluation Action and Monitoring of Traumatic Brain Injury (TEAM-TBI) is a monitored, multiple interventional research identifying clinical profiles and assigns individualized, evidence-based treatment program. The objective of the current study was to assess overall participant satisfaction of the multi-disciplinary care team and approach. METHODS: Between 2014 and 2017, 90 participants completed the 4-day TEAM-TBI clinical intake evaluation resulting in individualized treatment recommendations followed by a six-month intervention phase follow-up. Inclusion criteria were: age 18-60, history of chronic TBI (>6 months post-injury) with refractory clinical sequelae at screening (Post-Concussion Symptom Scale [PCSS] score >30). RESULTS: A total of 85/90 (94%) participants completed the survey at baseline focusing on intake evaluation and approach; 90% of eligible participants also completed the follow-up time-point. Hundred percent of participants had a mean score of >4 across all questions at the initial time point." CONCLUSIONS: The multi-disciplinary care approach and individualized treatment plans of the TEAM-TBI study yielded high participant retention and satisfaction scores. The Clinical Coach component of the trial was one of the highest rated aspects of the program and was associated with participant motivation and high retention rates.

The Glasgow Coma Scale (GCS): Deciphering the Motor Component of the GCS.

The Glasgow Coma Scale (GCS) was developed to standardize the assessment of neurologically compromised patients, to assist in triaging severity of injury, and to direct management decisions for an individualized plan of care. This examination allows for frequent assessments to ascertain worsening of neurological symptoms that would warrant additional radiological scans or interventions. The GCS score is composed of three components: eye, verbal, and motor, with motor being the most difficult to assess. A need for clarification of the motor component of the GCS was identified in a neurotrauma intensive care unit (ICU) at a level 1 hospital in the United States. The aim of this article is to illustrate the need for clear, common language to describe the patient's motor response to a painful stimulus post head injury, to avoid communication breakdown between healthcare professionals. Proper training and understanding of the components of the GCS, particularly the motor component, will lead to proper use of the scale and thus clearer communication among healthcare professionals. Pre- and post-GCS training tests were administered during educational sessions, with demographics collected. A focus of training was on the motor component of the GCS. A multiple-choice selection included all motor score choices. Tests were de-identified with a matching number to calculate prescoring and postscoring. Of the 54 nurses tested, 50% incorrectly completed the pretest, of which 37% had ≥5 years ICU experience. Moreover, 93% of the posttests were correct. Further evaluation is required to assess accuracy of communicating examination findings to physicians and documentation in the electronic record.

Lifetime attributable risk of cancer from CT among patients surviving severe traumatic brain injury.

OBJECTIVE: The purpose of this study was to determine the lifetime attributable risk of cancer from CT among patients surviving severe traumatic brain injury. MATERIALS AND METHODS: A retrospective cross-sectional study was conducted with prospectively collected data on patients 16 years old and older admitted with a Glasgow coma scale score of 8 or less to a single level 1 trauma center from 2007 to 2010. The effective dose of each CT examination the patients underwent was predicted with literature-accepted effective dose values of standard helical CT protocols. The lifetime attributable risk of cancer and related mortality incurred as a result of CT were estimated with the cumulative effective dose incurred from the time of injury to a 1-year follow-up evaluation and with the approach established by the Biologic Effects of Ionizing Radiation VII report. RESULTS: The average patient was a 34-year-old man. The median number of CT examinations received during the first 12 months after injury was 20, and the average cumulative effective dose was 87 ± 45 mSv. This resulted in increases in the lifetime incidence of all cancer types from 45.5% to 46.3% and in the lifetime incidence of cancer-related mortality from 22.1% to 22.5%. CONCLUSION: Radiation exposure from the use of CT in the evaluation and management of severe traumatic brain injury causes negligible increases in lifetime attributable risk of cancer and cancer-related mortality. Treating physicians should not allow the concern for future risk of radiation-induced cancer to influence decisions regarding radiographic evaluation in the acute treatment of traumatic brain injury.