In treating severe brain injuries, doing more pays off, study finds

About 1.5 million Americans suffer a traumatic brain injury every year. It’s also emerged as the leading injury in the conflicts in Iraq and Afghanistan.

A new study examines the cost-effectiveness of aggressive treatments for severe brain injury — a device monitoring pressure inside the brain (intracranial monitoring), and removing parts of the skull to allow the brain to swell out (decompressive craniotomies) to reduce pressure.

These treatments are part of the guidelines set by the Brain Trauma Foundation, but remain controversial. Some experts say these expensive treatments do not really result in better patient outcomes.

University of Pennsylvania researchers compared outcomes and costs for 1,000 patients who received different treatments.

Some received “comfort care” where they spent very little time in the intensive care unit. Others received “routine care” where the guidelines of the Brain Trauma Foundation were followed less than 50 percent of the time.

Penn researcher Dr. Robert Whitmore found that the expensive and aggressive interventions pay off in the long run.

“If you calculate the cost over the lifetime of the patient, so those costs include not just the price of the more aggressive therapies but also long-term nursing care, it turns out that the more aggressive strategy leads to better outcomes and also lower cost over the life time of the patient,” Whitmore said.

The outcomes were measured in terms of patients’ recovery, and their ability to take care of themselves after the injury.