Research investigates the treatment of traumatic brain and head injury

The National Institute for Health Research Health Technology Assessment (NIHR HTA) programme is expanding the evidence base surrounding the treatment of traumatic brain and head injury (TBI) by commissioning four new research projects. If left untreated many patients with head injury will rapidly develop complications which may lead to death or permanent disability. More than 100,000 people in the UK have long-term effects caused by such injuries. Prompt medical treatment may prevent the worsening of symptoms and lead to a better outcome.

A £2.3 million clinical trial will assess whether or not surgery is of benefit to patients with a bleed or bruise inside the brain following a head injury. At present it is known that patients with a bleed on the surface of the brain following a head injury benefit from urgent surgery but it is not known whether patients with a bleed inside the brain would also benefit from surgery.

Researchers based at neurosurgery at Newcastle University will randomly allocate participants to either receive early surgery to remove the blood from the brain or receive best medical treatment and delayed surgery if they deteriorate. To view the full project details visit www.hta.ac.uk/1756

A second study is reviewing the existing evidence around head cooling in adults after traumatic brain injury and stroke. A raised temperature is common and damaging to the brain after brain injury and stroke, therefore reducing patients' temperature could reduce brain damage.

Researchers at the University of Edinburgh will assess if head cooling can reduce brain temperature and result in less disability and fewer deaths. They will also look at whether head cooling affects other indicators of brain damage, such as brain pressure, side effects and how effectively temperature is reduced. For further information on this project visit www.hta.ac.uk/1777

Another study is conducting a prospective validation of risk prediction models for adult patients with acute traumatic brain injury (TBI). The National Institute for Health and Clinical Excellence (NICE) Guideline into head injury recommends that all patients with a severe brain injury caused by trauma should be treated within a specialist neuroscience centre.

"Despite these guidelines many patients are not. There are a number of reasons why not all patients with TBI are either treated in, or transferred to, a neuroscience centre including initial location of the patient post-trauma, bed availability in the neuroscience centres and local variation partly due to the clinical assessment of the severity of the TBI," says lead researcher Dr David Harrison, Intensive Care National Audit and Research Centre. "An accurate risk prediction model, developed and validated on a large number of NHS patients with TBI could be used both to provide sufficient robust evidence to address this issue and ensure standard clinical assessment of severity."

An additional study is evaluating the cost-effectiveness of investigation and hospital admission for minor (GCS 13-15) head injury. A small minority of these patients will have bleeding around their brain, despite appearing to have made a full recovery. If this can be diagnosed early and operated on then their chances of returning to normal health are increased. Researchers, led by Professor Steve Goodacre of the University of Sheffield, will review all available scientific studies of tests for minor head injury and develop a model to explore how each testing strategy would work in practice. This will allow them to weigh the benefits of early detection and treatment of bleeding against the costs and inconvenience of testing, and determine the most appropriate strategy for the NHS.

The HTA programme has commissioned these research projects as part of a themed call in 2007 for research proposals in the areas of emergency medicine, pre-hospital care and trauma, which saw nine proposals funded in total. Visit www.hta.ac.uk/funding/themedcalls/trauma.shtml