Researchers will compare patients with brain injury in the United States to those in Argentina
The NeuroTrauma Research Group of Oregon Health & Science University will host a team of physicians and researchers from Argentina this week as they work together to evaluate the effects of rehabilitation on the recovery of patients who suffer traumatic brain injury (TBI). OHSU's NeuroTrauma team is working with Argentine researchers on a study that will compare TBI patients in the United States who do receive rehabilitation to TBI patients in Argentina who do not. In Argentina, standard care for TBI patients does not include rehabilitation. Originally, the OHSU team was awarded $1.4 million by the National Institute on Disability Rehabilitation and Research (NIDRR) to conduct a study of brain injury in the United States. NIDRR, an agency of the Department of Education, then awarded the team an additional half a million dollars to extend the research to Argentina.
Treatment of brain injury in Argentina captured the attention of the OHSU team and the Department of Education because the acute-care treatment of brain injury in Argentina has reached a level of quality comparable to that of the United States, thanks to the efforts of intensive care physicians who are members of the S.A.T.I. society (Sociedad Argentina Terapia Intensiva - the Argentine Society for Intensive Care Therapy). By following treatment guidelines endorsed by the World Health Organization, S.A.T.I. physicians have decreased their in-hospital death rate by approximately 45 percent . However, in Argentina there is no rehabilitation after discharge from the intensive care units, and no provision within the country's social structure to care for this growing pool of disabled people. Concern for the long-term care of their patients led S.A.T.I. physicians to partner with Randall Chesnut, M.D., professor of neurological surgery in OHSU's School of Medicine and an author of the World Health Organization guidelines for TBI treatment.
"If we can clearly establish the value of rehabilitation for TBI patients, countries like Argentina will have the information they need to better allocate the scarce resources they have to provide care to these patients," said Chesnut. "The impact of this study could also benefit more medically advanced countries like the United States by providing evidence that resources for rehabilitation used at specific stages of treatment are clearly beneficial to the patient." Chesnut shares the role of principal investigator for this study with Carlos Rondina, M.D., chief of trauma at Hospital Emergencias in Rosario, Argentina, and a leader of the S.A.T.I. society.
To establish the effectiveness of rehabilitation treatments, the recovery of a group of patients who receive the treatment must be compared to the recovery of a group of patients who do not. This is difficult to accomplish in the U.S., where most patients receive some form of rehabilitation. This study will be the first in TBI research to have a comparison group of patients who, while receiving high quality acute care, receive absolutely no rehabilitation. Researchers will compare 200 patients in Argentina who sustained brain injury to a matched sample of cases drawn from the Oregon Traumatic Brain Injury Model System Project based at OHSU, and the National TBI Model System Database. The database is part of a study that follows TBI patients long after they leave the hospital to determine the value of long-term follow-up care and support. The project will evaluate general measures of recovery, including death rates and complications, as well as measures of social reintegration and employment several years after the initial injury.
OHSU's research team traveled to Argentina at the onset of the project in August, 2000, to train the Argentine personnel and establish protocols for patient evaluation and data collection that would be comparable to those of the U.S. study. The project is being conducted in five hospitals, four in Buenos Aires and one in Rosario. Members of OHSU's NeuroTrauma group visit the hospitals several times a year to provide ongoing support and conduct quality evaluations of the program. "What is exciting about this project is that we have the potential to make a very big impact on patient care in Argentina with a minimum of resources and effort, and at the same time accomplish an exchange of information that will benefit the U.S. as well," said Nancy Carney, Ph.D., director of the Argentina Project and assistant professor in OHSU's Division of Medical Informatics.
After their visit to Oregon, the Argentine group will travel to Washington, D.C. with members of OHSU's NeuroTrauma Research Group to present the results of their project to NIDRR's senior staff and the directors of the national Traumatic Brain Injury Model System Project.