Associate Professor Daniel HolenaPerelman School of Medicine, University of Pennsylvania, Philadelphia, USA
Dr. Holena is an associate professor of surgery and epidemiology at the University of Pennsylvania where he serves as the section chief of Emergency Surgery. He has worked as a trauma surgeon at the Hospital of the University of Pennsylvania since 2009. After completing a Masters of Science in Clinical Epidemiology though the Center for Clinical Epidemiology and Biostatistics in 2015 while on a K12 training grant, in 2016 he was awarded K08 training grant through the National Heart Lung and Blood institute (K08 HL131995) to gain further expertise epidemiologic methods and experience in the conduct of clinical research the in the trauma population. His areas of research include trauma systems, the interhospital transport of injured patients, and the application of the Failure to Rescue (FTR) metric to trauma populations.
|
|
Does Treatment Location Make a Difference in the Outcome of Patients with Traumatic Brain Injury?
It is estimated that over 50% of the world’s population will sustain a traumatic brain injury (TBI) within their lifetime, and TBI remains a leading cause of mortality in young adults. In New Zealand alone, TBI was responsible for 503 disability-adjusted life years per 100,000 people in a single year. Improving systems of care for TBI patients should be a high priority to reduce morbidity and mortality, but the optimal hospital destination after suspected TBI remains unclear. In some cases, the nearest hospital may not offer specialized neurological care, raising the question of whether it is better to take the patient with suspected TBI to that hospital or to bypass to a center capable of rendering advanced injury care. A single cluster-randomized trial failed to accrue enough patients to answer this question while at the same time raising logistical issues that suggest further randomized trials are unlikely to be successful at this time. Retrospective studies on this topic are mixed, but a recent instrument variable approach suggests that in TBI patients >65 years of age, specialized neurologic care is associated with a 3.4% reduction in mortality. Until a definitive answer is reached, trauma providers will need to balance the potential risks and benefits of these two approaches in the context of their local environments.
It is estimated that over 50% of the world’s population will sustain a traumatic brain injury (TBI) within their lifetime, and TBI remains a leading cause of mortality in young adults. In New Zealand alone, TBI was responsible for 503 disability-adjusted life years per 100,000 people in a single year. Improving systems of care for TBI patients should be a high priority to reduce morbidity and mortality, but the optimal hospital destination after suspected TBI remains unclear. In some cases, the nearest hospital may not offer specialized neurological care, raising the question of whether it is better to take the patient with suspected TBI to that hospital or to bypass to a center capable of rendering advanced injury care. A single cluster-randomized trial failed to accrue enough patients to answer this question while at the same time raising logistical issues that suggest further randomized trials are unlikely to be successful at this time. Retrospective studies on this topic are mixed, but a recent instrument variable approach suggests that in TBI patients >65 years of age, specialized neurologic care is associated with a 3.4% reduction in mortality. Until a definitive answer is reached, trauma providers will need to balance the potential risks and benefits of these two approaches in the context of their local environments.
