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Study Questions Standard of Care for Head Trauma
Date:12/12/2012

By Steven Reinberg
HealthDay Reporter

WEDNESDAY, Dec. 12 (HealthDay News) -- Monitoring pressure build-up in the brain after a severe head trauma is critical, and a combination of CT scans and neurological exams may work as well as the current, more invasive method, a new study suggests.

Intracranial pressure typically is measured with a sensor device that is inserted into the patient's head using a catheter or screw. The device keeps constant track of pressure in the brain, which is important because too much pressure can result in permanent damage.

"The study challenges the long-held belief that patients require intracranial, invasive monitoring," said Dr. Robert Glatter, an emergency-room physician at Lenox Hill Hospital in New York City. Glatter was not involved in the study.

"The study shows that a good clinical exam combined with appropriate imaging really has the potential to be as good as serial measurements of intracranial pressure when you are trying to assess response to serious head trauma," he said.

"It's too soon, however, to make a judgment about replacing the current practice with scans and exams," he added. "Larger studies are essential to really confirm the findings of this study."

The report was published Dec. 12 in the New England Journal of Medicine.

For the study, a team lead by Dr. Randall Chesnut, a neurosurgeon at Harborview Medical Center in Seattle, randomly assigned more than 300 patients in hospitals in Bolivia and Ecuador to intracranial pressure monitoring or CT scans and clinical exams.

Specifically, the researchers looked for survival and mental functioning three and six months after the head trauma.

They saw virtually no difference between the outcomes of patients on intracranial monitoring and those who were evaluated with CT scans and clinical exams. The mortality rates after six months were 39 percent in the intracranial-pressure-monitorin
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