Physician begins national head-trauma registry to track why, how injuries happen

January 24, 2002

Each year, emergency room physicians treat more than 1 million patients for head injuries, many due to outdoor recreational activities. Doctors will report anecdotally that sledding and snow boarding seem to be the biggest wintertime culprits, yet physicians really do not have the data to make accurate predictions about this major public health issue.

But a new surveillance program at the University of Rochester Medical Center could lead to better prevention and become a nationwide model. Jeffrey Bazarian, M.D., assistant professor in Emergency Medicine, has received a $560,000 National Institutes of Health grant to start the nation's first Emergency Department-based traumatic brain injury registry.

The 18-month project involves collecting details about every head-injury patient who comes to the E.D. at the university's Strong Memorial Hospital. Trained interviewers will ask patients or their families questions such as: Exactly where did the injury happen? How? Was a sport involved? Was the patient intoxicated? Wearing a helmet or seatbelt? Bazarian will also scrutinize the medical data to evaluate what type of imaging tests were performed or what medications were prescribed. He will track patients during recovery to find out which ones were more likely to have lingering problems such as dizziness, or an inability to concentrate.

This level of information is currently missing from hospital charts across the United States, Bazarian says, because most institutions do not have the time, personnel or technology to collect it. Therefore, when the Centers for Disease Control or other public health agency wants to review data on head injuries, the records are too vague to make useful conclusions.

"If we really want to design a prevention program, we need to know everything that happened during each injury, in great detail," Bazarian says. "Only then would we be able to look for things like geographic clusters or other environmental conditions that contribute to head injuries."

The UR Medical Center is well positioned for this project. Its Emergency Department already employs people who are specially trained to interview patients for possible enrollment in research studies. Strong Hospital is also plugged into a statewide electronically coded pre-hospital data system. This allows emergency medical technicians across New York to enter patient information into a computer system that ultimately becomes part of the patient's hospital chart.

Once Bazarian begins collecting head injury details, he can begin scientifically testing hypotheses. For example, although men are most likely to suffer head injuries, women have worse outcomes, according to a preliminary study of emergency patients done by Bazarian. Ultimately, the research could help physicians decide if hormonal differences play a role in recovery, and if so, how diagnosis and treatment should change.

Personal experiences prompted Bazarian to investigate brain injuries. His father died in 1993 of a head injury after falling down a flight of stairs. And as an emergency room physician, he sees plenty of seasonal head traumas in summer due to bicycles and scooters, in autumn from football and soccer, and on outdoor playgrounds year round.

One goal of Bazarian's research is to reduce the disabilities from head injuries. Although many head injuries are relatively minor concussions, about 50 percent of these patients still suffer from headaches and other symptoms for as long as three months, Bazarian says. A full 25 percent of patients with concussions will have significant disabilities for six months afterward.

"Some people think there is such a thing as a mild concussion," adds Sandra M. Schneider, M.D., professor and chair, Department of Emergency Medicine. "But what we are learning from Dr. Bazarian and others in this field is that even a mild head injury can have significant consequences at least for a while."

"Prevention is the key," Bazarian says. "In addition, having a surveillance system in place will allow us to eventually test new medications or other treatments for head injuries."

University of Rochester Medical Center

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