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Cross-Post: We need more than brain injury awareness: We need new treatment

By Cross Post, TBI, Traumatic Brain InjuryNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places that we believe will interest our readers. Today’s op-ed originally appeared on Roll Call. Rep. Bill Pascrell Jr. (D-N.J.), co-chair and founder of the Congressional Traumatic Brain Injury Task Force, and Vishal Bansal, MD, FACS, discuss the need for more than brain injury awareness — the need for new treatment.

Each March, Brain Injury Awareness Month promotes learning more about brain injury and ending its dangerous effects. The American Association of Neurological Surgeons puts annual direct and indirect costs of the full spectrum of traumatic brain injuries (TBI) — from mild to severe — at $48 billion to $56 billion in 2019 and $76.5 billion today. More than 3 million patients visit hospital emergency rooms with suspected TBI annually.

Rep. Pascrell and Dr. Bansal state, “We have achieved widespread acknowledgment in recent years that TBI is a public health issue that contributes to disability and death. Yet, little has changed in the standard of care for concussions as the medical community is still striving for therapy that would treat both the symptoms and the underlying concussion. We can do more and should do better.”

Despite progress, concussions are still a significant unmet medical need. The authors conclude the op-ed by stating that more resources are needed today to support cutting-edge research and development for effective treatments for concussion.

Click here to read the full article.

Editor’s Note: We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtags #neurosurgery and #BrainInjuryAwareness.

How a Small Education Campaign Helped Change the Landscape of Concussion Education and Policy

By Guest Post, TBI, Trauma, Traumatic Brain InjuryNo Comments

Figure 1: CDC HEADS UP materials 2003 through present

This March, in recognition of Brain Injury Awareness Month, we want to take a moment to reflect on the momentous progress that has been made related to concussion education over the last 20 years. During that time, the Centers for Disease Control and Prevention’s (CDC) HEADS UP concussion education initiative started as a small campaign and grew to become an integral part of concussion education. This had a substantial impact on concussion laws and policies nationwide.

In the Children’s Health Act of 2000 (H.R. 4365) (Library of Congress, 1999–2000), Congress charged CDC to develop a public information campaign to broaden public awareness of the health consequences of traumatic brain injury. In response, in 2003, CDC released the HEADS UP: Brain Injury in Your Practice tool kit for health care providers. The goal of the tool kit was to improve awareness among primary care providers about the diagnosis and management of mild traumatic brain injury, an under-diagnosed and under-identified injury. Since then, CDC HEADS UP has become the go-to resource for concussion prevention and education — reaching millions of Americans with concussion information. CDC HEADS UP materials cover how to prevent, recognize and respond to a possible concussion or other serious brain injury. It has grown to include materials for health care providers, coaches, parents, school professionals, sports officials, and kids and teens (Figure 1). Some successes of CDC HEADS UP include:

  • Reaching more than 200 million people through ad campaigns, PSAs and more;
  • Partnering with more than 85 organizations (including the American Association of Neurological Surgeons and the Congress of Neurological Surgeons) across the fields of athletics, health care, public health, education and scientific research; and
  • Creating over 100 communication products to promote concussion prevention and care.

Educating People and Communities

One of the biggest achievements of CDC HEADS UP has been its ability to support the implementation of Concussion in Sports laws that now exist in all 50 states and the District of Columbia. Concussion in sports laws (sometimes referred to as return-to-play laws) was first passed in Washington state in 2009. These laws focus on concussion safety for youth. Most require that coaches and others involved in youth sports receive training on concussion identification and response before the start of the sports season. CDC HEADS UP provides six online training courses designed for coaches, health care providers, school professionals, athletic trainers and sports officials (Figure 2). The availability of these quality training courses (at no cost) allows states, sports programs and schools to comply with education requirements contained in concussion in sports laws and policies. To date, more than 10 million people nationwide have completed at least one of these six training courses.

Figure 2: CDC HEADS UP online training courses on concussion used nationwide to implement state concussion policies and laws

Importantly, CDC HEADS UP educational initiatives and materials align with the best scientific

evidence available on concussion prevention and management. Studies show that CDC HEADS UP materials:

  • Increase communication about concussion between athletes and their parents;1
  • Reach a large number of coaches and parents and improve their knowledge about concussions;2-4
  • Lead coaches and others to view concussion more seriously;3,5,6
  • Increase the capacity of youth sports coaches to prevent, recognize and respond to sports-related concussions appropriately;6
  • Improve knowledge about symptom resolution and return-to-play recommendations;3,6 and
  • Improve awareness of underreporting of concussions among athletes.3

CDC HEADS UP to the Future!

CDC HEADS UP has contributed to a new landscape of concussion awareness in the United States — building, improving and supporting concussion safety around the country. However, the work of the campaign is not yet done. Exciting upcoming CDC HEADS UP initiatives include:

  • An updated and expanded training for youth sports coaches—the most popular CDC HEADS UP product;
  • Resources to help parents of toddlers and young children learn about concussion safety, prevention and care; and
  • Enhanced efforts to reduce disparities through concussion educational materials tailored for American Indian/Alaska Native, Black and Hispanic parents and youth.
  • Make a Difference Where You Live

CDC works to put HEADS UP concussion materials into the hands of parents, healthcare and school professionals, coaches, athletes and others. You can support this mission by:

In 2023, we celebrate 20 years of CDC HEADS UP’s contribution to the substantial strides in educating the public about concussion. Together we all can play a part in ensuring that the next generation of children is better protected from concussions and their potentially serious effects.


  1. Zhou, H., Ledsky, R., Sarmiento, K., DePadilla, L., Kresnow, M.J., Kroshus, E. (2022).Parent–Child communication about concussion: What role can the Centers for Disease Control and Prevention’s HEADS UP concussion in youth sports handouts play? Brain Injury, 36:9, 1133-1139,
  2. Parker, E. M., Gilchrist, J., Schuster, D., Lee, R., & Sarmiento, K. (2015). Reach and Knowledge Change Among Coaches and Other Participants of the Online Course: “Concussion in Sports: What You Need To Know.” Journal of Head Trauma Rehabilitation, 30(3), 198–206.
  3. Daugherty, J., DePadilla, L., & Sarmiento, K. (2019). Effectiveness of the US Centers For Disease Control and Prevention Heads Up Coaches’ Online Training as an Educational Intervention. Health Education Journal, 78(7), 784–797.
  4. Rice, T., & Curtis, R. (2019). Parental Knowledge of Concussion: Evaluation of the CDC’s “HEADS UP to Parents” Educational Initiative. Journal of Safety Research, 69, 85–93.
  5. Daugherty, J., DePadilla, L., Sarmiento, K. (2020). Assessment of HEADS UP online training as an educational intervention for sports officials/athletic trainers. Journal of Safety Research, 74:133-141.
  6. Covassin, T., Elbin, R. J., & Sarmiento, K. (2012). Educating Coaches About Concussion in Sports: Evaluation of the CDC’s “HEADS UP: Concussion In Youth Sports” Initiative. The Journal of School Health, 82(5), 233–238.

ThinkFirst About Brain Injury: A Call to Action

By TBI, Traumatic Brain InjuryNo Comments

In a previous position, I worked at a level 1 trauma center where the chief of neurosurgery referred to some trauma patients as “dingbats.” He did not always use the appellation, generally reserving it for people who injured themselves while intoxicated or through risk-taking behaviors. Still, he sometimes used it generically about any trauma patient. One time, an emergency medicine resident rotating on our service corrected him, noting, “Oh, this guy is not a dingbat. He was working when he fell off the roof. He wasn’t drunk. His wife and kids are worried sick about his brain injury.”

The chief was a respected and well-liked physician with an excellent neurosurgical reputation. He was known for his sense of humor that was often deemed “not politically correct.” Like many neurosurgeons, he perhaps coped with the stress of the job by incorporating dark humor. He would counsel younger neurosurgeons that the way to avoid burnout was to not come in at night or on weekends to operate on “dingbats” — advice that his partners heeded. One of them once told an emergency room physician that his brain injury consult “was not worth my getting out of bed in the middle of the night.”

There are several obvious problems that with this chief’s mindset. A neurosurgical chief who is dismissive or disparaging of the brain-injured patient demonstrates a lack of understanding of neurodiversity and risk-taking behaviors. Human beings are not uniformly cautious, and it may be that some level of risk-taking behavior favors the evolution of our species and society. The majority of Americans likely do not know, for example, that falls are a leading cause of brain injury in people over the age of 65 and that exercise programs and other interventions can reduce their likelihood.

Traumatic injury, and particularly brain injury, has significant psychological consequence. The incidence of affective disorders, psychiatric hospitalization and suicide are higher in people who have sustained a brain injury versus those who have not. When a person sustains a brain injury, there is often a sense of hopelessness created, at least in part by physicians saying there is nothing they can do to help.

In addition to re-examining their behavior and language, neurosurgeons can take five actions to provide the best care for patients in the context of traumatic injury consults

  1. Improve diversity in leadership positions and in all aspects of neurosurgical practice. We need to have people in our clinics and hospitals who can relate to the patients they treat, share their cultural and social backgrounds and understand their rationale in making decisions.
  2. Support patients with brain and other traumatic injuries with positive language. Neurosurgeons should familiarize themselves with the scientific literature regarding brain injury outcomes. Patients should always be referred to a brain injury rehabilitation doctor for follow-up if possible. If not possible, patients should receive separate referrals to physical, occupational, speech, vestibular and cognitive therapy or neuropsychology as needed. Neurosurgeons who see many patients with brain injury should consider hiring an advanced practice provider dedicated to following these patients.
  3. Advocate for legislation supporting risk-reductive measures. Seatbelt, child seat and helmet laws all reduce brain and other traumatic injuries. Measures to control the distribution of firearms also reduce risk. Neurosurgeons need to be vocal with their elected officials, so they understand the connection between firearms and morbidity and mortality.
  4. Advocate for better insurance — including Medicare and Medicaid coverage of brain injury diagnostics and therapeutics. Neurosurgeons need to help their patients and others get the help that they need.
  5. Support ThinkFirst and other mechanisms for injury prevention education. ThinkFirst is an international not-for-profit organization founded by members of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons to enable coordinated education in injury prevention. It has developed curricula for injury reduction for all ages, including babies (inflicted abuse), teens (driving safety) and the elderly (fall prevention.) If there is no chapter at your hospital or clinic, consider starting one. Neurosurgeons can also sponsor a chapter at an underserved location or support other ThinkFirst programs. Educating people to identify risk factors for brain injury is the best way to keep these patients out of your emergency room.

Editor’s Note: March is the first annual ThinkFirst Awareness Month. We encourage everyone to join the conversation online by using the hashtags #ThinkFirstAwareness and #ThinkFirst2021.

Uzma Samadani
University of Minnesota
Minneapolis, Minn.

Cross-Post — Neurosurgery Publishes Decompressive Craniectomy Update to the Guidelines for the Management of Severe Traumatic Brain Injury

By CNS Spotlight, Cross Post, TBI, Traumatic Brain InjuryNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places when we believe they hit the mark on an issue. Clinical guidelines have widespread impact and practical utility for practitioners. We want to bring attention to these updates, which recently appeared in Neurosurgery, the official journal of the Congress of Neurological Surgeons, which publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology and medicine.

In September of 2020, Neurosurgery published “Guidelines for the Management of Severe Traumatic Brain Injury: 2020 Update of the Decompressive Craniectomy Recommendations,” adding to the 2017 publication, “Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition,” in the spirit of living guidelines.

According to the Brain Trauma Foundation press release, this update “delineates key knowledge gaps which remain insufficiently informed by evidence.” Incorporating new evidence from the RESCUEicp study and 12-month outcome data from the DECRA study, these guidelines provide three new level-IIA recommendations and validates a previously presented level-IIA recommendation.

To read the full Neurosurgery article, click here.

Editor’s Note: We encourage everyone to join the conversation online by using the hashtag #TBI.