Wednesday, 18 June 2014

Nearly Headless at the "Heads, shoulders, knees and toes" Physiotherapy Trauma Day

In April Prof Jamie Cooper gave a Harry Potter themed presentation at the Department of Physiotherapy’s "Heads, shoulders, knees and toes" Trauma Day to 80 physiotherapists from across Victorian acute hospitals and rehab centres. Prof Cooper used the DECRA trial to highlight the importance of long-term outcomes in clinical research.
Prof Cooper was Chief Investigator for the DECRA trial, the first ever multicentre randomised controlled trial of a surgical therapy for severe head injury, fast tracked for publication in the New England Journal of Medicine in 2011 (Cooper DJ, Rosenfeld JV, Murray L, Arabi YM, Davies AR, D’Urso P, Kossman T, Ponsford J, Seppelt I, Reilly P, Wolfe R. Decompressive Craniectomy in Diffuse Traumatic Brain Injury. N Engl J Med 2011;364(16):1493-502).

The trial demonstrated worse long-term outcomes for an increasingly popular intervention (early decompressive craniectomy) that was opposite to apparent short-term benefits and has initiated international TBI practice review. This is the first Level I evidence in this area and will be incorporated into international practice guidelines. Using alternative therapies will improve patient outcomes and substantially reduce health care spending on lifetime care of severe disability survivors. The DECRA trial publication was described as a “fundamental event in the history of decompressive craniectomy for TBI” (B J Neurosurg 2011;25:441-2), and as “one of the most important clinical trials of a novel therapy for severe TBI, and a class 1 study which should be considered as foundation for an evidence based guideline” (Lancet Neurol 2011;10:497-8). The repercussions for the neurotrauma community of these novel and unexpected findings have been substantial including improved long-term patient outcomes and major financial savings to the Australian health care system. The translation of the DECRA trial was estimated in a Medical Journal of Australia editorial to save the Australian health care system >$100 million annually.

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