Marlena M. Wald

The epidemiology and impact of traumatic brain injury: a brief overview

Traumatic brain injury (TBI) is an important public health problem in the United States and worldwide. The estimated 5.3 million Americans living with TBI-related disability face numerous challenges in their efforts to return to a full and productive life. This article presents an overview of the epidemiology and impact of TBI.

Using a cost-benefit analysis to estimate outcomes of a clinical treatment guideline: testing theBrain Trauma Foundation guidelines for the treatment of severe traumatic brain injury.

BACKGROUND A decade after promulgation of treatment guidelines by the Brain Trauma Foundation (BTF), few studies exist that examine the application of these guidelines for severe traumatic brain injury (TBI) patients. These studies have reported both cost savings and reduced mortality. MATERIALS We projected the results of previous studies of BTF guideline adoption to estimate the impact of widespread adoption across the United States. We used surveillance systems and national surveys to estimate the number of severely injured TBI patients and compared the lifetime costs of BTF adoption to the current state of treatment. RESULTS After examining the health outcomes and costs, we estimated that a substantial savings in annual medical costs (

Reduced Mortality in Injured Adults Transported by Helicopter Emergency Medical Services

262 million), annual rehabilitation costs (

Information and literacy in a time of AIDS: observations of Ethiopia today: a case for grey literature

43 million) and lifetime societal costs (

Traumatic brain injury in the United States; emergency department visits, hospitalizations, and deaths, 2002-2006

3.84 billion) would be achieved if treatment guidelines were used more routinely. Implementation costs were estimated to be

ProTECT: A Randomized Clinical Trial of Progesterone for Acute Traumatic Brain Injury

61 million. The net savings were primarily because of better health outcomes and a decreased burden on lifetime social support systems. We also estimate that mortality would be reduced by 3,607 lives if the guidelines were followed. CONCLUSIONS Widespread adoption of the BTF guidelines for the treatment of severe TBI would result in substantial savings in costs and lives. The majority of cost savings are societal costs. Further validation work to identify the most effective aspects of the BTF guidelines is warranted.

Surveillance for traumatic brain injury-related deaths--United States, 1997-2007.

Abstract Background. Some studies have shown improved outcomes with helicopter emergency medical services (HEMS) transport, while others have not. Safety concerns and cost have prompted reevaluation of the widespread use of HEMS. Objective. To determine whether the mode of transport of trauma patients affects mortality. Methods. Data for 56,744 injured adults aged ≥18 years transported to 62 U.S. trauma centers by helicopter or ground ambulance were obtained from the National Sample Program of the 2007 National Trauma Data Bank. In-hospital mortality was calculated for different demographic and injury severity groups. Adjusted odds ratios (AOR) were produced by utilizing a logistic regression model measuring the association of mortality and type of transport, controlling for age, gender, and injury severity (Injury Severity Score [ISS] and Revised Trauma Score [RTS]). Results. The odds of death were 39% lower in those transported by HEMS compared with those transported by ground ambulance (AOR = 0.61, 95% confidence interval [CI] = 0.54–0.69). Among those aged ≥55 years, the odds of death were not significantly different (AOR = 0.92, 95% CI = 0.74–1.13). Among all transports, male patients had a higher odds of death (AOR = 1.23, 95% CI = 1.10–1.38) than female patients. The odds of death increased with each year of age (AOR = 1.040, 95% CI = 1.037–1.043) and each unit of ISS (AOR = 1.080, 95% CI = 1.075–1.084), and decreased with each unit of RTS (AOR = 0.46, 95% CI = 0.45–0.48). Conclusion. The use of HEMS for the transport of adult trauma patients was associated with reduced mortality for patients aged 18–54 years. In this study, HEMS did not improve mortality in adults aged ≥55 years. Identification of additional variables in the selection of those patients who will benefit from HEMS transport is expected to enhance this reduction in mortality.

The impact of screening, brief intervention, and referral for treatment on emergency department patients' alcohol use

Reviews the poor availability of white literature on AIDS, for use by both health workers and the general public in Ethiopia, as a case for using grey literature to raise awareness.