Acute Severe Traumatic Brain Injury: Lessons Learned and Prospects for Future Treatment

April 17, 2013; 1-2:30 p.m. (ET)


Severe TBI occurs much less frequently than concussion (mild TBI) but typically results in long-term disability. Severe TBI is the most common cause of death and disability in those between the ages of one and 40. Among the estimated 1.7 million people diagnosed with TBI each year, about 50,000 have severe injuries.
In this webinar, the speaker will define severe TBI and identify its causes and incidence in civilian and military populations. He will review the most commonly associated intracranial lesions and examine the focus of acute treatment of severe TBI. Finally, he will explore possible reasons for the limited success of current clinical trials and discuss recommendations for future trials.


Donald W. Marion, MD, MSc.
Senior Clinical Consultant, Clinical Affairs Defense and Veterans Brain Injury Center Dr. Donald Marion is an academic neurosurgeon who has focused on the clinical pathophysiology and treatment of TBI for more than 25 years. He was among the charter authors of the Brain Trauma Foundation’s “Guidelines for the Management of Severe Traumatic Brain Injury” and published the first clinical report to show the benefit of therapeutic moderate hypothermia for TBI (The New England Journal of Medicine, 1997). He is the editor of a book entitled “Traumatic Brain Injury,” and he has authored or co-authored more than 200 journal articles and book chapters, mostly related to TBI. Dr. Marion’s previous positions have included professor and chair of the Department of Neurosurgery, The Boston University School of Medicine; professor and vice-chair, Department of Neurosurgery, The University of Pittsburgh School of Medicine; and director of the Brain Trauma Research Center at the University of Pittsburgh. He is past chair of the Joint Section on Neurotrauma and Critical Care of the American Association of Neurological Surgeons and Congress of Neurological Surgeons; past president of the National Association of Injury Control and Research Centers; and past chair of the Neurosurgery Subsection, the Committee on Trauma of the American College of Surgeons.


Katherine (Kathy) M. Helmick, MS, CRNP, ANP-BC, CNRN
Deputy Director Defense and Veterans Brain Injury Center Ms. Helmick is the deputy director of DVBIC. She brings considerable clinical, educational and research experience in the field of neuroscience to include more than 100 regional, national and international presentations and more than 15 peer-reviewed publications. Ms. Helmick has served in a variety of leadership, advisory and operational roles, including deputy director for the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; deputy director for the Clinical and Educational Affairs Office for DVBIC; manager of the Office of Clinical Standards at DVBIC; neurological surgery nurse practitioner at Hodes Neurosurgery in Louisville, Ky.; nurse practitioner/clinical care coordinator at the University of Louisville Hospital; and clinical research coordinator in the Division of Neurosurgery at the Medical College of Virginia Hospitals. Ms. Helmick holds both bachelor’s and master’s degrees in nursing from Virginia Commonwealth University, as well as a Bachelor of Science in family and child development from Virginia Tech University. She has earned the following certifications: Adult Nurse Practitioner (ANP) through the American Nurses Credentialing Center and Certified Neuroscience Registered Nurse (CNRN) through the American Board of Neuroscience Nursing.

Continuing Education

This webinar has been approved for the following:

1.5 AMA PRA Category 1 Credits™

1.5 Credits by the American Psychological Association

1.5 Nursing contact hours as a co-provider with the American Nurses Credentialing Center

1.75 CE Contact hours for Physical Therapist and Assistant approved by the State of Illinois

1.75 CE Contact hours for Occupational Therapist and Assistant approved by the State of Illinois

1.5 CEHs for Social Work approved by the Missouri Division of Professional Registration Committee for Social Work

Additional Resources

Acute Severe Traumatic Brain Injury

  1. Coma Recovery Scale (Revised) (Giacino, J. & Kalmar, K., 2006)
  2. Prognostic Model For Predicting Outcome Following TBI (BMJ 2008 doi:10.1136/bmj.39461.643438.25 2007).
  3. Rancho Los Amigos Scale: The Revised Levels- Third Edition (Hagen, C., 1998)
  4. Rancho Los Amigos Scale: Patient and Family Information on Cognitive Functioning Information Sheet ( © Los Amigos Research and Educational Institute (LAREI), 1990).
  5. Talking With Children About Moderate or Severe TBI brochure
  6. CDC Severe Traumatic Brain Injury
  7. Nursing Management of Adults with Severe Traumatic Brain Injury (Mcilvoy, L., Meyer, K., 2009).

Current References authored or co-authored by our speaker

  1. Marion DW: Current Diagnostic and Therapeutic Challenges. In: Tsao, JW (ed): Traumatic Brain Injury, New York, NY: Springer 2012: 313-323.
  2. Marion, DW: Evidenced-Based Guidelines for Traumatic Brain Injuries. In: Pollock BE (ed): Guiding Neurosurgery by Evidence ((Series: Lunsford LD (ed): Progress in Neurologicial Surgery, Vol 19)) Basel: Karger 2006: 171-196.
  3. Meyer KS, Marion DW: Traumatic Brain Injury. In: Vincent JL, Abraham E, Moore FA, Kochanek PM, Fink MP (eds): Textbook of Critical Care, 6th edition, Philadelphia, PA: Elsevier Saunders 2011: 220-230.

Additional Current References for Severe TBI

  1. Jacobs B, Beems T, van der Vliet TM, Diaz-Arrastia RR, Borm GF, Vos PE. Computed tomography and outcome in moderate and severe traumatic brain injury: hematoma volume and midline shift revisited. J Neurotrauma. 2011 Feb;28(2):203-15.
  2. Arabi YM, Haddad S, Tamim HM, Al-Dawood A, Al-Qahtani S, Ferayan A, Al-Abdulmughni I, Al-Oweis J, Rugaan A. Mortality reduction after implementing a clinical practice guidelines-based management protocol for severe traumatic brain injury. J Crit Care. 2010 Jun;25(2):190-5.
  3. Alban RF, Berry C, Ley E, Mirocha J, Margulies DR, Tillou A, Salim A. Does health care insurance affect outcomes after traumatic brain injury? Analysis of the National Trauma Databank. Am Surg. 2010 Oct;76(10):1108-11.
  4. Kejriwal R, Civil I. Time to definitive care for patients with moderate and severe traumatic brain injury--does a trauma system matter? N Z Med J. 2009 Sep 11;122(1302):40-6.
  5. Kramer C, Freeman WD, Larson JS, Hoffman-Snyder C, Wellik KE, Demaerschalk BM,Wingerchuk DM. Therapeutic hypothermia for severe traumatic brain injury: a critically appraised topic. Neurologist. 2012 May;18(3):173-7.

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