Almost 5 million Americans are evaluated for traumatic brain injury (TBI) in emergency departments annually, and, in 2017, there were almost 224,000 TBI-related hospitalizations and an estimated 61,000 deaths attributed to TBI. These statistics are cited in a report Traumatic Brain Injury: A Roadmap for Accelerating Progress, released February 1 by an ad hoc National Academies of Sciences, Engineering, and Medicine (NASEM) Committee on Accelerating Progress in Traumatic Brain Injury (TBI) Research and Care. Helene Moriarty, PhD, RN, FAAN, the Diane & Robert Moritz Jr. Endowed Chair in Nursing Research at the Fitzpatrick College of Nursing, worked for over a year with the committee on its recommendations - one of two nurses in the group of 18 experts representing many disciplines.
Dr. Moriarty, also a Nurse Scientist at the Corporal Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia, says, “To see all our committee work culminate in this report is very exciting – it is a blueprint for action.” The report provides eight recommendations for enhancing TBI care, research, and systems for continual education and quality improvement. She notes it was a stimulating, collaborative process with colleagues from across the spectrum of TBI care, whose deep commitment to TBI care and research was quite evident. Chairing the committee was Dr. Donald Berwick, President Emeritus and Senior Fellow, Institute for Healthcare Improvement, and NASEM study staff facilitated the process.
The committee conducted a study, sponsored by the Department of Defense, that gathered input from a wide range of public and private experts and stakeholders, ultimately for this report that identifies barriers, outlines potential areas for collaboration, and provides a 10-year roadmap for advancing TBI research and clinical care. Issues for both military and civilian populations were included.
From its Highlights report, NASEM lists key areas:
· Create and implement an updated TBI classification system
· Manage TBI as both a complete acute and a chronic condition
· Ensure quality and consistency of care
· Enhance awareness and understanding of TBI
· Establish and reinforce integrated care delivery systems for TBI
· Establish an effective learning care system for TBI
· Invest in continued research
· Provide leadership to drive collaboration and change.
Dr. Moriarty applauded the inclusion of the voices of stakeholders such as patients and family members in the process of public workshops. TBI has a profound impact on patients and families, and the committee recognized the need for more research on interventions to support families during the acute, post-acute and chronic stages of TBI. Dr. Moriarty points out that the report also maps out the stages of the care journey after TBI. The report notes that TBI is not an acute, isolated event. It can be a chronic long-term condition, and persons with TBI should be able to access care for as long as they need it. Patients may have long-term TBI symptoms, but there are fewer rehabilitation services and other community resources available to them and their families. “Patients and families often feel alone and unsupported,” she explains.
In highlights from the report, NASEM states that “because of the brain’s complex roles, a TBI can affect not only how a person feels but also how they interact with the people and larger community around them.” To understand and address a person’s needs after TBI, use of a bio-psycho-socio-ecological (BPSE) framework for TBI care and research is emphasized. Dr. Moriarty shares that the report also stresses the need for increased public awareness around TBI and its symptoms, and the importance of seeking care. Further, the report recommends better provider education because many, for instance, mental health and primary care providers, often serve people with TBI and their families but may lack the knowledge to address their unique needs.
The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.
National Academies of Sciences, Engineering, and Medicine 2022. Traumatic Brain Injury: A Roadmap for Accelerating Progress. Washington, DC: The National Academies Press. https://doi.org/10.17226/25394.