ACS Programs Help Trauma Centers Coordinate TBI Care

Advances in traumatic brain injury (TBI) assessment offer opportunities to individualize treatment, but translating those advances into coordinated care remains a challenge. A National Academies of Sciences, Engineering, and Medicine workshop, held October 19–20 in Washington, DC, examined pathways that connect injury recognition and acute treatment with rehabilitation, follow-up, and long-term services.

At the workshop, “Building Integrated Care Pathways for Traumatic Brain Injury—From Enhanced Characterization to Coordinated Care,” Avery Nathens, MD, PhD, FACS, Medical Director of ACS Trauma Quality Programs, outlined how the College can support more consistent TBI care.

Dr. Nathens highlighted trauma center verification, best practices guidelines, performance improvement, and benchmarking through the Trauma Quality Improvement Program (TQIP). Together, these resources establish expectations for trauma centers, help teams identify gaps in care, and provide data for comparison with peer centers. He emphasized opportunities to connect these resources with more precise patient risk stratification.

“We can produce guidelines for care that align better with risk stratification at a level of concreteness that allows for implementation,” he said.

The ACS’s 2024 TBI Best Practices Guidelines combine available evidence and expert opinion, including  guidance for patients with multisystem injuries. Dr. Nathens emphasized that trauma centers can use the guidelines to compare current practice with recommended care, identify gaps, and monitor improvement. He also distinguished these voluntary recommendations from verification standards, which establish requirements for trauma center resources and processes.

Although the guidelines address blood-based biomarkers, they do not yet incorporate the clinical-biomarkers-imaging-modifiers (CBI-M) framework explored during the workshop.

TQIP data illustrate why these efforts matter. Dr. Nathens described substantial variation among centers in ICU admission for mild TBI, intracranial pressure monitoring, and withdrawal of life-sustaining treatment. He highlighted how protocols can identify patients who may benefit from an intervention and guide subsequent treatment. 

Looking ahead, he identified opportunities to incorporate selected CBI-M elements into the National Trauma Data Standard, expand benchmarking beyond severe TBI, and share successful implementation strategies through the TQIP Annual Conference. ACS efforts to automate data capture also could reduce the burden of collecting data and support more detailed assessment of care. 

Together, these steps could help trauma teams turn more precise assessments into coordinated care.

A recording of the workshop is available for free on the National Academies website.