Head Injury (Neurotrauma) Program

Elmhurst Hospital Center/The Mount Sinai Hospital

Jamie S. Ullman, M.D.

Director of Neurosurgery, Elmhurst Hospital Center

Severe head injury, while representing only 10 percent of all head injuries, is an important cause of death and disability in our population, especially among young people. Severe head injury (SHI) is defined by prolonged loss or significantly altered consciousness after an impact to the head. This impact results in coma. Such injury can be caused by direct impact to the skull by an object, fall, missile, or sudden acceleration/deceleration, such as happens in car accidents.

In the past, one out of two patients died after sustaining a severe had injury, and a great deal still do not make it to the hospital. Over the years, there has been a greater emphasis in major centers on critical care management. Also many experimental studies have defined some of the factors that influence bad outcomes. Through attention to these factors, SHI mortality has decreased to as much as 20-30 percent - one in four or five patients.

At Elmhurst Hospital Center, the primary teaching affiliate of Mount Sinai School of Medicine, a protocol was introduced for the management of severe head injury patients. This protocol involves rapid surgery for patients with large blood clots or bruises that can cause pressure on the brain within the skull cavity. There is a heavy emphasis on minute-to-minute, hour-to-hour critical care management. Monitoring of the pressure within the brain and the skull cavity, the intracranial pressure (ICP), is a mandatory part of this management in most patients. This monitoring can help to tell us when the brain might be suffering decreased oxygen delivery, called ischemia. Ischemia is the primary factor involved in the after the moment of impact; it is the secondary injury process. This on-going process might very well effect the patient's ultimate recovery. The secondary injury process affects more nerve cells than the initial bruises and bumps to the brain at the time of the accident. Elmhurst Hospital Center in Queens (a member of the New York City Health and Hospitals Corporation) is a 911-designated Level One Trauma Center that cares for approximately 17-18,000 trauma patients per year. The Surgical Trauma Service consists of physicians who see and treat all injured patients including those with head injuries. Through diligence and speed, patients are identified and treated in the early periods of their injury.

At Elmhurst, the emphasis is prevention of the secondary injury process. A state-of-the-art, modern 12-bed Surgical Trauma Intensive Care Unit is where all patients are monitored and treated. With specially trained medical and nursing staff, blood pressure, ICP, brain tissue oxygenation, and other important parameters are closely watched and manipulated. There is 24-hour critical care, neurosurgery, and surgical expertise available. Diagnostic imaging such as CT scanning and operating room services also available at all times.After the acute care, many patients undergo acute inpatient rehabilitation. When possible, patients continue their care at at the Mount Sinai Hospital Traumatic Brain Injury (TBI) Unit. This unit has special programs to treat patients with varying degrees of brain damage. The ultimate goal is to integrate patients back into society.

In the past, there was little hope for the survival and function of severely head injured patients. Through innovations in technology, research, and medical care, there has been a significant change in this belief. Elmhurst Hospital Center provides the very best in acute head injury care while providing the avenues for continuing rehabilitation of such patients.