San Francisco General Hospital Awarded the Nation’s First Traumatic Brain Injury Center Certification!

Traumatic brain injury (TBI) is the leading cause of death and disability for Americans under the age 45 and is increasing in prevalence globally.  By 2020, TBI is projected to become the third leading cause of morbidity and mortality in the world for persons of all ages.  There is also now increasing public recognition of the long-term health consequences of concussions, especially those sustained during sports and in the battlefield.

Against this background, it should come as good news that recent clinical evidence shows that state-of-the-art TBI care at medical centers with specialized units for the treatment of head trauma greatly reduces death rates and prevents disability, especially if care can be administered rapidly after the injury.  Therefore, the Joint Commission, the central body for accreditation of health care performance standards, has designated TBI as one of the disorders for which hospitals may seek certification for excellence.  In this way, treatment of TBI is becoming more similar to that of stroke, where it is widely understood that "time is brain", and for which many hospitals have gained Joint Commission certification as stroke centers.

San Francisco General Hospital (SFGH) recently became the first medical center in the USA to achieve certification from the Joint Commission for the treatment of TBI and, as such, now sets the standard for other hospitals to follow.  Four specific areas were cited as crucial to the TBI accreditation: the medical skills of the health care providers, neuromonitoring equipment and expertise in the Neuro Intensive Care Unit, medical imaging technologies and research.

The UCSF Department of Radiology and Biomedical Imaging plays an important role in the care of head injury patients at SFGH and contributes to the excellence in patient management that was recognized by the Joint Commission certification.  The CT and MRI scanning facilities at SFGH, including advanced capabilities such as CT angiography, CT perfusion, diffusion MRI, and blood-sensitive MRI, represent the imaging technologies that improve diagnosis, prognosis, and treatment monitoring of head trauma.  This advanced equipment is put to use by the superb skills of the technologists that perform the imaging exams and the highly-trained neuroradiologists that interpret them.  The high volume of TBI seen at SFGH contributes to the superior level of experience of the physicians and technologists providing imaging services, which in turn improves patient care.

The Department of Radiology, in collaboration with the Department of Neurosurgery and the Brain and Spinal Injury Center (BASIC) at SFGH, also plays a vital role in TBI research, as noted by the Joint Commission.  Two current imaging projects involving TBI patients are funded by the National Institutes of Health (NIH).  The first is a study of mild TBI using serial scans including functional MRI (fMRI) of brain activity and diffusion tensor imaging (DTI) of brain connectivity to examine the disruption of memory and attention caused by concussions.  The second is a large multi-center study of TBI using both CT and MRI that includes medical centers in New York, Pennsylvania, and Texas, for which UCSF serves as the primary site.  In addition to scans at SFGH, enrolled study patients also receive state-of-the-art 3 Tesla MRI scans at the UCSF Center for Molecular and Functional Imaging at China Basin Landing. UCSF radiology and neurosurgery investigators recently received NIH funding for a study of computer-based cognitive training, including exercises to improve attention and memory, for the treatment of persistent cognitive difficulties following concussion.  In this new project, fMRI and DTI are used to monitor the changes in brain activity and brain connectivity produced by the training exercises.

In this way, the cutting-edge TBI research at UCSF and SFGH promises to lead to better health and well-being for the sufferers of head injury.