Inside Duke Medicine

Program screens trauma patients for brain injury

A new program at Duke University Hospital is now screening all adult trauma service patients for traumatic brain injury, which can result in long-term physical, behavioral and cognitive impairments.

The Division of Speech Pathology and Audiology and Adult Trauma Services, both in the Department of Surgery, teamed up to create a Traumatic Brain Injury (TBI) program, so that all inpatients admitted to Adult Trauma Services with blunt force injuries above the neck now receive a TBI screening by Speech Pathology within 24 hours of admission.

“Our goal was to develop a comprehensive program to identify appropriate patients with TBI and provide services that were not being offered previously,” said Carlee Jones, clinical coordinator in the Division of Speech Pathology and Audiology. She worked closely with Carolyn Foley, RN, trauma clinical coordinator, as well as a multidisciplinary group of health care providers, to develop the program.

Traumatic brain injury occurs when sudden trauma causes damage to the brain. Each year, 1.5 to 2 million people sustain TBI, which can affect a person’s memory, ability to focus, and problem-solving skills, as well as cause many other impairments. Such impairments are often undiagnosed and untreated, Jones said.

TBI has received nationwide attention due to the fatal brain injury actress Natasha Richardson recently suffered during a ski accident and the thousands of U.S. soldiers who have sustained blast injuries in Iraq and Afghanistan, Jones said.

“Research is being conducted and programs are being funded to learn more about TBI and to offer rehabilitation programs for returning soldiers. This emphasis has also led to increased awareness and programmatic changes in non-military institutions across the country,” she said.

The Speech Pathology team at Duke uses a screening tool that includes five main areas to identify TBI. These include looking at the brain CT results, determining if there was a loss of consciousness, determining if there was amnesia, inquiring about changes in mental status, and using the Glasgow Coma Scale, a 15-point neurological scale that provides a standardized way of recording a person’s state of consciousness. If a patient fails any part of this TBI screening, he or she will receive a comprehensive speech-language-cognitive evaluation.

Traumatic brain injury impacts communities and trauma centers across the nation, and is the leading cause of trauma deaths at Duke Trauma Center, said Steven Vaslef, M.D., Ph.D., associate professor, in the Division of General Surgery and medical director of the Duke Trauma Center.

“The greater magnitude of TBI is distinguished by the life-altering disability of the survivor, which may range from mild to devastating.

Advantages of initiatives such as our TBI program include recognition and capture of potential TBI patients, early assessment, and timely referrals enabling the team to plan patient care and seek appropriate resources or placement for this challenging patient population,” he said.

As an outcome of the inpatient TBI program and to improve continuity of care, the Division of Speech Pathology and Audiology re-evaluates the inpatients with TBI in the outpatient clinic for cognitive-communicative impairments four weeks after discharge.

“This outpatient follow-up helps patients and families receive appropriate services and referrals when they return to their home-life and work,” said Frank DeRuyter, Ph.D., professor and chief of the Division of Speech Pathology and Audiology.

The program has been highly successful in identifying and serving patients with TBI and is one-of-a-kind in the region, Jones said.