Using a Cost-Benefit Analysis to Estimate Outcomes of a Clinical Treatment Guideline: Testing the Brain Trauma Foundation Guidelines for the Treatment of Severe Traumatic Brain Injury

Faul, Mark; Wald, Marlena M.; Rutland-Brown, Wesley; Sullivent, Ernest E.; Sattin, Richard W.

doi:10.1097/ta.0b013e3181493080

Cited by 185 publications

(126 citation statements)

References 15 publications

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“…18 This leads to great suffering for patients and their relatives, with huge direct and indirect costs to society. 10,32 It has been estimated that the annual costs of TBI in the US are more than $76.5 billion.9 Numerous clinical trials have failed to demonstrate the efficacy of promising experimental neuroprotective agents despite convincing preclinical data. Over the past 2 decades there have not been clear improvements in the prognosis of patients with TBI.…”

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confidence: 99%

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Alcohol and mortality after moderate to severe traumatic brain injury: a meta-analysis of observational studies

Raj¹,

Mikkonen

Siironen³

et al. 2016

JNS

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T raumaTic brain injury (TBI) is defined as an alteration of brain function, or other evidence of brain pathology, caused by an external force.28 Moderate to severe TBI is a major cause of mortality and morbidity in the world. 27 Every year approximately 1.5 million people die and 10 million people are hospitalized due to TBI. 18 This leads to great suffering for patients and their relatives, with huge direct and indirect costs to society. 10,32 It has been estimated that the annual costs of TBI in the US are more than $76.5 billion.9 Numerous clinical trials have failed to demonstrate the efficacy of promising experimental neuroprotective agents despite convincing preclinical data. Over the past 2 decades there have not been clear improvements in the prognosis of patients with TBI. 24,25 Description of the interventionUp to half of all patients with TBI are under the influence of alcohol at the time of injury. 44,49 Clinical studies investigating the role of alcohol (ethanol, CH 3 CH 2 OH, referred to as alcohol in the present study) on the outcome of TBI have been either retrospective or observational, as it probably would be unethical, unless strong evidence can be laid out, to administer alcohol to patients presenting with TBI. This meta-analysis investigates the impact of the presence of blood alcohol concentration (BAC) on outcome after TBI. How Might alcohol work as a Neuroprotective agent?The neuroprotective properties of alcohol have been abbreviatioNs AIS = Abbreviated Injury Scale; BAC = blood alcohol concentration; GCS = Glasgow Coma Scale; NMDAR = N-methyl-d-aspartate receptor; TBI = traumatic brain injury. but with good study homogeneity (I 2 = 36% and 14%). coNclusioNs Positive BAC was significantly associated with lower mortality rates in moderate to severe TBI. Whether this observation is due to selection bias or neuroprotective effects of alcohol remains unknown. Future prospective studies adjusting for TBI heterogeneity is advocated to establish the potential favorable effects of alcohol on outcome after TBI.

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confidence: 99%

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confidence: 99%

Alcohol and mortality after moderate to severe traumatic brain injury: a meta-analysis of observational studies

Raj¹,

Mikkonen

Siironen³

et al. 2016

JNS

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“…The International Classification of Diseases, Tenth Edition, codes S00-S09, covers injuries to the head (S06 is specifically 'intracranial injury'), but on initial admission to hospital it may not always be obvious whether or not brain injury is due to trauma, and patients may have other injuries and complex disease classification. In the USA there has been a concerted effort to collect data and consequently much more information is available, 103,104 but, unfortunately, the health-care system is too different for this to translate to the UK. However, because this review has highlighted the lack of lifetime data on TBI, steps are now being taken in Scotland to address the situation and we are working with a group of people under the auspices of the Acquired Brain Injury Managed Clinical Network to improve data collection on TBI.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of head cooling in adults after traumatic brain injury and stroke

Harris

Andrews²,

Murray³

et al. 2012

Health Technol Assess

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An electronic version of this title, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable DVD is also available (see below).Printed copies of HTA journal series issues cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our despatch agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per issue and for the rest of the world £3 per issue. How to order:-fax (with credit card details) -post (with credit card details or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you to either print out your order or download a blank order form. Contact details are as follows:Synergie UK (HTA Department) Digital House, The Loddon Centre Wade Road Basingstoke Hants RG24 8QW Email: orders@hta.ac.uk Tel: 0845 812 4000 -ask for 'HTA Payment Services' (out-of-hours answer-phone service) Fax: 0845 812 4001 -put 'HTA Order' on the fax header Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to University of Southampton and drawn on a bank with a UK address.Paying by credit card You can order using your credit card by phone, fax or post. SubscriptionsNHS libraries can subscribe free of charge. Public libraries can subscribe at a reduced cost of £100 for each volume (normally comprising 40-50 titles). The commercial subscription rate is £400 per volume (addresses within the UK) and £600 per volume (addresses outside the UK). Please see our website for details. Subscriptions can be purchased only for the current or forthcoming volume.How do I get a copy of HTA on DVD?Please use the form on the HTA website (www.hta.ac.uk/htacd/index.shtml). HTA on DVD is currently free of charge worldwide.The website also provides information about the HTA programme and lists the membership of the various committees. HTA NIHR Health Technology Assessment programmeThe Health Technology Assessment (HTA) programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care. The research findings from the HTA programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service' . The HTA programme is needs led in that it fills gaps in the evidence needed by the NHS. There are three routes to the start of projects. First is the commissioned route. Suggestions for research...

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“…The savings are likely to be substantial, magnified if the brain injury occurs early in age and if one includes the impact of the TBI on the family and caregivers. A conceptually similar analysis was performed to determine the cost-effectiveness of adopting the existing Brain Trauma Foundation guidelines for acute care of severe TBI that suggested an annual savings in medical costs ($262 million), rehabilitation costs ($43 million), and lifetime societal costs of $3.84 billion (Faul, Wald, Rutland-Brown, Sullivent, & Sattin, 2007).…”

Section: Delivery Of Assessment and Treatment Servicesmentioning

confidence: 99%

Call for an Integrative and Multi-Disciplinary Approach to Traumatic Brain Injury (TBI)

Mansour¹,

Lajiness-O’Neill²

2015

PSYCH

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Much has been gained in our understanding of the psychopathology, assessment, and treatment of TBI. Still lacking is the breadth and depth that an integrative and multi-disciplinary approach to TBI portends. While there is a greater awareness of a need for such a systems-based approach as evidenced by the number of professional organizations and government agencies recently advocating a need for standardization in the collection data in TBI, the application of multi-dimensional approach, and the development novel strategies to deliver prevention, assessment and treatment to large, diverse populations, we are still in the early stages in making this important shift. In the nearer term, there are clinical assessment and interventional programs that can be developed and empirically validated to bring us closer to this integrative, multi-disciplinary ideal. The following review calls for a universal diagnostic classification system for TBI, integration of pathophysiology and pharmacological and rehabilitative therapies, development of treatments addressing disorders comorbid with TBI, and the delivery of assessment and treatment services to large underserved populations.

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Using a Cost-Benefit Analysis to Estimate Outcomes of a Clinical Treatment Guideline: Testing the Brain Trauma Foundation Guidelines for the Treatment of Severe Traumatic Brain Injury

Abstract: Widespread adoption of the BTF guidelines for the treatment of severe TBI would result in substantial savings in costs and lives. The majority of cost savings are societal costs. Further validation work to identify the most effective aspects of the BTF guidelines is warranted.

Cited by 185 publications

References 15 publications

Alcohol and mortality after moderate to severe traumatic brain injury: a meta-analysis of observational studies

Alcohol and mortality after moderate to severe traumatic brain injury: a meta-analysis of observational studies

Systematic review of head cooling in adults after traumatic brain injury and stroke

Call for an Integrative and Multi-Disciplinary Approach to Traumatic Brain Injury (TBI)

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