Telling a doctor what he or she should do for a particular patient
can be a real challenge, especially when you are trying to get a bunch of
physicians and physician-scientists together in a room to all agree
on a particular protocol.
And generally speaking, I think some of the greatest studies that were done--a couple
of them were done by a guy by the name of Randy Chesnut,
who was trying to follow how often these things were followed throughout the United States.
And it wasn't too long ago that you would be treated one way in Los Angeles
and another way in San Diego and another way in New York
and another way in Massachusetts,
and that has been reduced.
That variability has been reduced.
Is there still variability? You bet there still is.
There are people who are very strong advocates at what we call hypothermia
and other people who are strong advocates of increasing mean arterial blood pressure
and what we call cerebral perfusion therapy.
Most people have some--have now a more basic understanding
of everything that they are going to work on that we naively call evidence-based medicine.
And what I mean by naively is that we want some sort of a trial, and in some
cases things are so obvious that we don't have time to do a trial.
If you don't see any blood flow in the brain, you have to get some blood flow in the brain
otherwise it's just not going to work.
If you want to do a trial and you say, okay, I'm going to deprive this person of
blood flow and this person we're going to give blood flow, that's a ridiculous trial.
You can't do that.
So when the rubber meets the road, there are some variations that slip in,
but generally within the United States there is--
what we were like 20 years ago and what we are today is a vast improvement.
We still have probably 40 or 50 percent of the institutions around the
United States that need to improve to reach that standard,
but it's much better than we had none.
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Today versus 20 years ago, the standards of care for TBI across the US have vastly improved. However, these standards could certainly be higher and more consistent across all medical centers.
Produced by Noel Gunther, Ashley Gilleland, and Brian King, BrainLine.
David A. Hovda, PhD, David Hovda, PhD is the director of the UCLA Brain Injury Research Center. He is past president of the National Neurotrauma Society and past president of the International Neurotrauma Society. He has served as chair of study sections for the National Institute for Neurological Disease and Stroke.
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