High-level trauma care may limit disability

Reuters – 1 hr 27 mins ago NEW YORK (Reuters Health) - People treated for severe injuries at a specialized trauma center may survive with fewer disabilities than those at other hospitals, a study from Australia suggests.

The findings, researchers say, add to evidence that patients fare better when they're treated under an organized trauma system -- where hospitals, emergency services and state governments have coordinated plans for getting the right patients to the appropriate treatment.

So-called Level I trauma centers provide the most comprehensive care for traumatic injuries and have to meet certain requirements -- like having a specific number of surgeons and other specialists on duty 24 hours a day.

Studies have found that for severely injured people, getting care at a Level I trauma center can cut the risk of dying by 25 percent.

But there'd been some question about whether that drop in death rates might mean more people are surviving with severe disabilities, according to Belinda J. Gabbe, the lead researcher on the study from Monash University in Melbourne.

"Our study shows that care at specialized trauma centers improves the chances of a better functional outcome -- that is, less disability, which really strengthens the evidence for organized trauma systems," Gabbe told Reuters Health in an email.

The study, reported in the Annals of Surgery, found that of nearly 5,000 seriously injured patients treated in the state of Victoria's trauma system, those seen at a Level I center tended to be less severely disabled one year later.

The sample included people who'd been in a car or motorcycle accident or had suffered a fall with head, chest or spinal cord injuries.

Overall, 35 percent of patients had a "good" recovery -- either back to their healthy selves or with some disruption to their daily activities and relationships.

The odds of a better recovery were 22 percent higher for patients treated at Level I centers versus similar patients at other hospitals.

Overall, patients' outlook also got better over time -- with generally lower levels of disability among patients treated in 2008-2009 versus 2006-2007.

Gabbe said it's not clear why that is.

But, she added, it might be due to the "maturing" of the state's trauma system.

In the U.S., about 45 million people live more than an hour away from a Level I or Level II trauma center (by ambulance or helicopter), according to the Centers for Disease Control and Prevention.

Like Victoria, where this study was done, some U.S. states have statewide trauma systems that aim to get the right patients to the right hospital as quickly as possible.

But there are also county-level systems.

"There are studies from San Diego, Los Angeles, Maryland and Milwaukee showing similar results" as the current one, said Dr. Raul Coimbra, who heads the division of trauma, surgical critical care and burns at the University of California, San Diego Health System.

So the new findings are "not novel," according to Coimbra, who was not involved in the study.

But, he said in an email, "the findings provide additional support to the concept that organized, regionalized systems of care

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When Does Boxing-Related Head Trauma Become Too Much?

HealthDay – 29 mins ago WEDNESDAY, April 18 (HealthDay News) -- Professional fighters may hit a threshold -- a specific number of fights and years in the ring -- where they can no longer take blows to the head without brain damage, a new study suggests.

But, once they cross that threshold, years might pass before symptoms show.

"The brain can tolerate or absorb a certain amount of trauma and repair itself," explained study author Dr. Charles Bernick. The findings raise the question of whether -- and when -- fighters should be medically screened, so changes could be caught earlier and available treatment offered, he said.

It's already well documented that "the more exposure you have to head trauma, the higher your risk of developing long-term complications. Primarily, this condition is chronic traumatic encephalopathy," said Bernick, associate director of the Lou Ruvo Center for Brain Health at the Cleveland Clinic in Ohio.

Also known as Boxer's Syndrome, chronic traumatic encephalopathy is a degenerative brain disease that causes the same kinds of thinking difficulties and personality changes seen with Alzheimer's disease.

As part of an ongoing study on brain health, the researchers divided 109 licensed boxers and mixed martial artists into three groups: those who had fought for less than six years, six to 12 years or more than 12 years. Their average age was about 29.

Participants underwent MRI scans to measure their brain volume and tests of their thinking and memory.

"In those that fought less than six years, we didn't find any changes," Bernick said. For that group, he said, "the more you fought didn't seem to make any differences in the size of brain structure or their performance on some of the tests like reaction time."

But for the other two groups of boxers and combat athletes, "the greater number of fights, the sizes of certain volumes of the brain were decreasing," he said. "But, it was only in those that fought more than 12 years that we could detect the changes in performance in reaction time and processing speed."

Women made up about 10 percent of the fighters in the study, too small a number to make any comparisons for now, Bernick said.

The study, released April 18, will be presented at the American Academy of Neurology's annual meeting in New Orleans, held from April 21 to 28.

"This is a cross-sectional study -- just one point in time in all these fighters' lives," Bernick said. "It needs to be substantiated and confirmed, but it's biologically plausible and it makes sense, and we're going to be following up on that."

With repetitive head trauma, Dr. Howard Derman, medical director at the Methodist Concussion Center in Houston, said "boxing is clearly more dangerous than football, because the number of the hits to the head is greater," and no headgear is used at the professional level.

"The initial presentations may begin with things like deterioration in attention, concentration, memory, disorientation, confusion and then they get much bigger issues with dementia, and then it even progresses to parkinsonian features," Derman said. Parkinsonian features include rigidity and tremor.

Derman isn't convinced that a time lag always exists between early head injuries from sports and measurable brain changes.

"Most of us believe that there is the period of quiescence, which is why you're seeing a lot of these

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Trauma patients taken by chopper may fare better

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Emotional Trauma May Hurt Toddlers' Later Learning

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