The National Institutes of Health, or NIH, holds three Consensus Development Conferences each year. The goal of these conferences is to allow experts to present on an area of controversy in the medical community, then summarize these presentations in a consensus report. A Consensus Development Conference for traumatic brain injury was held from October 26 to 28, 1998 in Bethesda, Maryland.
Incidence
Traumatic brain injury, or TBI, is defined as any injury to the brain that is caused by an external trauma, such as vehicular accidents, falls, sports injuries and violent acts. Comparing the 1998 NIH Consensus Report with 2010 statistics from the Centers for Disease Control and Prevention, or CDC, the incidence of TBI seems relatively constant. Both reports indicate that approximately 1.7 million people are affected by TBI each year, with TBI contributing to over 30 percent of all injury-related deaths in the U.S., directly resulting in 52,000 deaths and 275,000 long-term hospitalizations. Despite these devastating effects, approximately 80 percent of the annual TBI sufferers are treated and released almost immediately.
Acute and Severe Effects
According to the 1998 NIH Consensus Report, the percentage of deaths caused by TBI continues to decrease each year due to increases in response time, faster transport to well-equipped hospitals and better and more efficient medical care. Among the more severe TBI cases, both the NIH Consensus Report and CDC agree that TBI's effects on thinking, sensation, emotion and language are potentially more damaging than its physical effects. As the CDC reports that 75 percent of TBI cases are mild concussions, however, they recommend that most cases can be treated by resting, taking time off from school or work, avoiding activities that could cause another head trauma and ceasing the use of alcohol and drugs not recommended by a doctor.
Detection and Treatment
According to the NIH Consensus Report, there is a greater need to identify those who do not seek treatment. When left untreated, undiagnosed or underdiagnosed TBI can ultimately result in a treatable case of TBI becoming a case of long-term disability or death. As such, identification and early detection may be the most important steps in treatment.
For more severe cases, the Consensus Report states that cognitive-behavioral therapy and rehabilitation involving physicians, family members, partners and people affected by TBI is the most effective long-term treatment available. Despite the increase in research and knowledge since the release of the Consensus Report, little has changed in the treatment of people with TBI since then.
TBI Continuum of Care
The NIH recommends the Brain Injury Association of America, or BIAA, for up-to-date treatment information for TBI. The BIAA's Continuum of Care, featuring current guidelines for the treatment of TBI, differs little from the treatment recommendations of the 1998 NIH Consensus Report. In line with the report's suggestions, the Continuum of Care focuses on intensive, immediate cognitive-behavioral therapy with long-term family and community involvement. Though the continuum begins with emergency care, moves to acute care and intensive rehabilitation, then leads to outpatient therapy, community reintegration and independent living, the BIAA acknowledges that the treatment of TBI can start, finish and restart at any point along the Continuum.
Continuum of Care and Consensus Report
Both the 1998 Consensus Report and BIAA Continuum of Care recommend cognitive-behavioral therapy, personalized rehabilitation programs, interdisciplinary treatment, long-term support and family and community involvement. Though the BIAA's guidelines generally follow the recommendations of the Consensus Report, advances in knowledge and research since then have led to some changes, particularly in the use of medications.
The Consensus Report recommends against the use of medications unless absolutely necessary, as too little was known about their potential side-effects at the time for the benefits to outweigh the potential risks. Though the BIAA primarily focuses on cognitive-behavioral and community treatments, a range of medications are suggested to help ease the rehabilitation process. These include analgesics for pain relief, anti-anxiety medications, anti-coagulants to prevent blood clots, anti-convulsants to prevent seizures, anti-depressants, anti-psychotics to treat hostility and hallucinations, sleep medications, muscle relaxants and stimulants to increase alertness and attention.
References
- NIH Consensus Development Program: About
- NIH Consensus Development Program: NIH Consensus Development Conference on Rehabilitation of Persons With Traumatic Brain Injury
- NIH Consensus Development Program: Rehabilitation of Persons with Traumatic Brain Injury Consensus Statement
- Centers for Disease Control and Prevention: Injury Prevention & Control; Traumatic Brain Injury; May 5, 2011
- Brain Injury Association of America: Brain Injury Treatment
