Monument Valley in Arizona

Volume 19, No. 3, 2003 Comments

Trauma team to the Emergency Room. Trauma team to the Emergency Room. Those of us who work in hospitals hear this message broadcast overhead far too often. And far too often a significant number of trauma patients harbor serious neurological injuries—as many as 50% of trauma victims require neurological evaluation or treatment. Neurotrauma is therefore an important aspect of neurological care, research, and training.

This issue of the Barrow Quarterly, spearheaded by Dr. Timothy R. Harrington, Director of Neurotrauma, considers clinical issues related to neurotrauma care and the larger social framework in which that care is provided. The first two articles analyze the existing trauma network since the introduction of the Emergency Medical Treatment and Active Labor Act. They propose building on the success of the current system to mitigate some of its weaknesses by developing super-regional neurotrauma centers established by voluntary designation, inspection, and accreditation. Such self-selected facilities would preferentially receive trauma patients who would then receive optimal trauma care from these dedicated centers of excellence—a proposal bound to engender some interesting discussions.

The issue then moves through the continuum of trauma care from existing tests and treatments and those that hold promise to priority areas in need of clarification through further research. Compared to computed tomography, the superior sensitivity of magnetic resonance imaging is beginning to improve the ability to predict long-term outcomes in patients with traumatic brain injuries (TBIs). The controversial role of craniectomy in the treatment of TBIs is also examined. The steady improvements in diagnostic imaging are increasing the frequency with which blunt traumatic vascular injuries involving the cervical carotid and vertebral arteries are recognized. Anticoagulation therapy remains the primary treatment for these injuries, but the placement of endovascular stents appears promising. Next, the complex issues involved with the emergent treatment of acute spinal cord injuries and the need for prospective, randomized clinical studies to determine the efficacy of immediate spinal cord decompression for such patients are addressed. The issue closes with an article that examines how neuropsychological evaluation can be used to improve patient management and to predict rehabilitation outcomes.

We at Barrow hope you, our readers, will find this issue both thought provoking and another valuable addition to your libraries. Please consider using the self-enclosed, stamped envelope to make a tax-deductible donation that will help us maintain the quality of the Barrow Quarterly. Thank you.

Robert F. Spetzler, MD