Aggressive traumatic brain injury care improves outcomes, reduces long-term costs

PHILADELPHIA – Aggressive treatment for severe traumatic brain injuries costs more than routine care, yet yields significantly better outcomes, improved quality of life, and lower long term care costs, according to a new study by researchers in the Perelman School of Medicine at the University of Pennsylvania. For example, in 20 year old traumatic brain injury survivor, aggressive care leads to significantly improved outcomes and costs nearly $100,000 less compared to routine care. Across age groups, the costs of aggressive care were outweighed by the beneficial outcomes and long-term cost savings. The study appears online in the Journal of Neurosurgery.

With 1.5 million traumatic brain injuries a year, leading to 200,000 hospitalizations and over 52,000 deaths, the economic costs (direct medical care and loss of productivity) of TBI are estimated to equal $60 billion. This is the first study to demonstrate the cost-effectiveness of intensive TBI care.

"This study clearly shows that aggressive care, for both young and older patients who suffer a severe traumatic brain injury, provides patients the best chance at surviving and recovering, and also reduces lifetime costs associated of TBI treatment," said Robert Whitmore, MD, Neurosurgery resident and the study's lead author.

Despite effective guidelines from the Brain Trauma Foundation, controversy remains regarding the invasive nature and expensive costs to aggressively treat severe brain injuries. As a result, expensive interventions like intracranial monitoring and decompressive craniotomies have been inconsistently performed.

"We've reached epidemic levels of traumatic brain injuries in the United States. Standardizing and optimizing care for the most severe TBI cases can improve outcomes, helping people get back to work and their families, lowering costs associated with long-term nursing care and lost productivity," said study co-author M. Sean Grady, MD, chair and professor of Neurosurgery at the Perelman School of Medicine. "Aggressively treating severe TBI patients, regardless of age, can lessen the financial impact that severe TBIs have on society as a whole."

In this study, collected from a prospective database of 1000 consecutive patients from the Hospital of the University of Pennsylvania, aggressive care was significantly more expensive than routine care or comfort care. It was also significantly more effective. Aggressive management of TBI, including invasive ICP monitoring and decompressive hemicraniectomy, was cost-effective across all patient populations, including older patients. In younger patients, the advantage was more significant, yet aggressive care in adults over 80 years old was still beneficial.

The study was funded by the National Institutes of Health's National Institute of Neurological Disorders and Stroke (5T32NS43126-08). In addition to Drs. Whitmore and Grady, study co-authors, all from Penn's Perelman School of Medicine, include Jayesh Thawani, MD, Joshua Levine, MD, Matthew Sanborn, MD, and Sherman Stein, MD.

Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $4 billion enterprise.

Penn's Perelman School of Medicine is currently ranked #2 in U.S. News & World Report's survey of research-oriented medical schools and among the top 10 schools for primary care. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $507.6 million awarded in the 2010 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania -- recognized as one of the nation's top 10 hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; and Pennsylvania Hospital – the nation's first hospital, founded in 1751. Penn Medicine also includes additional patient care facilities and services throughout the Philadelphia region.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2010, Penn Medicine provided $788 million to benefit our community.