Start with Low-Hanging Fruit in TBI Treatment
A great deal of good basic science research has and continues to get done, but mostly in silos. Standardizing what is known in clinical practice would be the smart way to optimize care for people with TBI.
See more of Dr. Ghajar's videos here.
I'm a pragmatist. I look at solutions. At the end of the day I want to see better outcomes for people with traumatic brain injury, whether it's mild or severe. And there's a lot of terrific science going on, a lot of terrific basic science. Unfortunately, it's being done in silos and it doesn't get applied. If you look at the last 20, 30 years of basic science research, it hasn't seen application. We've had 30+ pharmaceutical drug trials for traumatic brain injury. They've failed. A lot of it is because of practice variability. So if I was there, and say my mission is to improve the outcome of people with traumatic brain injury, I would focus first on what's a low-hanging fruit. Low-hanging fruit is practice variability. If I went out there and just changed people's practice and they would follow current evidence and the mortality drops by 50% and then I have a very scientifically proven drug that came out of basic research, that we're looking for a 5% to 10% change in mortality and yet I have a 50% change over here, where am I going to be putting my focus? I'd say I should be over here trying to get that 50% reduction in mortality. Then once the practice is standardized, then I look for the 5% to 10% improvement I get from this new drug. The problem is these 2 are coming at each other right now. And we've had a lot of drug trials, a lot of good basic science fail because we don't have standardization in our clinical practice. So when this drug or whatever it is comes to clinical trials, it fails. Not because it doesn't have inherent value; it's because of what's being practiced. So we need to standardize this, and then this will have-- It's no use doing the basic science part if we don't have this standardized. And I think that there's been, unfortunately, a lot of wasted effort on this other side, and we need to bring really good science at the bedside. I think we need to fund more clinical trials, I think we need to get more of the scientists at the bedside and see what's really going on. In terms of what we've been doing at the Brain Trauma Foundation, just the work of just applying what's already known and getting this enormous reduction in mortality and better outcomes, it would be great if we could get practice standardized and look at the efficacy of some of this very hard work that's being done in the basic sciences. It's an enormous amount of work. I'm sure it's frustrating for a lot of basic scientists who work in this area not to see whatever they're doing come to fruition or some practical effect. And so there needs to be a discussion at that point. How can we get this really good science integrated with clinical practice?
Posted on BrainLine February 9, 2012.
Jamshid Ghajar, MD, PhD is chief of Neurosurgery at Jamaica Hospital-Cornell Trauma Center, clinical professor of Neurosurgery at Weill Cornell Medical College and president of the Brain Trauma Foundation.
Produced by Noel Gunther and Justin Rhodes, BrainLine.