Los Angeles County + University of Southern California (LAC+USC) Healthcare Network

Model

The NeuroTrauma Journey

Our model is based on the concept of NeuroTrauma as a journey – a journey most of our patients and families never anticipated they would be making. Our Team faces the challenge of informing and educating families at a time of incredible emotional and psychological stress through honest yet compassionate communication. We guide families and patients through the worst to better times based on principles of supportive information delivery.

From arrival in the Department of Emergency Medicine until hospital discharge and through the processes of rehabilitation and reintegration, each member of Our Team brings expertise in intensive care, surgery, therapy, and counseling to guide patients and families through the transitions of the NeuroTrauma journey.

Hundreds of patients with brain or spinal cord injury present to the LAC+USC Department of Emergency Medicine (DEM) every year. In the DEM, many patients with neurotrauma are seen first by the Trauma Division (Department of Surgery) because, in addition to brain or spinal cord injury, these patients also have a thoracic, abdominal, or extremity injury.

The 18-bed Neuroscience ICU is state-of-the art allowing for the most advanced monitoring equipment. Intracranial pressure measurement is a cornerstone of management of brain injuries. More than 300 patients are admitted to the NSICU every year. The Neuroscience ICU has a multi-disciplinary team of pharmacy, nutrition, physical, speech, and occupational therapy that rounds with physicians and nurses and at each patient's bedside discusses care. Intracranial Pressure (ICP) Monitoring is done according to National Brain Trauma Foundation Guidelines for 2-3 patients weekly. A dedicated Neurosurgery OR and Emergency rooms are used to perform more than 100 neurotrauma – cranial and spinal – cases per year.

Some of the most severely brain and spinal cord injured patients do not do well. Some die, some remain in a Persistent Vegetative State (PVS). For some patients intensive care and surgery are futile and advanced directives authorize Withdrawal of Care and Organ Donation.

Fortunately, most brain injuries are mild or moderate. Post-concussive syndrome is characteristic of the chronic phase of brain injury in the vast majority of cases of mild to moderate injury. These patients frequently have no medical problems but are severely functionally disabled by emotional lability, irritability, depression, rage, apathy, etc. Management requires continued outpatient therapy and life skills counseling.

Patients who recover from their injury enough that they are able to cooperate with exercise regimens but are not ready for discharge home are transferred to inpatient Rehabilitation. Reintegration into society is the final challenge for the brain or spinal cord injury survivor. Family, school, job each present different challenges that the NeuroTrauma Team must help the patient and family overcome.

Recovery from a brain injury can take a long time and proceeds through stages in all patients. What varies from patient to patient is the lengths of the stages – and whether the patient passes through all of them to full recovery. Whatever a patient’s ultimate outcome, whether excellent or disappointing, every family guided through the NeuroTrauma journey by our Team knows that we have done the best that can be done competently and with compassion.