November 2003

Trauma treatment trial for new research centre

In a world first, doctors at the Alfred hospital are leading an Australia and New Zealand-wide trial investigating whether removing a part of the skull can improve a patient’s recovery following a severe head injury.

The study, known as the DECRA Trial, will compare the complex surgical procedure to more traditional methods of managing head injury, to determine which achieves the best outcome for patients.

The DECRA Trial is one of a number of brain injury research projects being lead by Alfred investigators at the National Trauma Research Institute (NTRI).

The NTRI, which incorporates the Victorian Trauma Foundation Centre for Trauma Research and Practice, is being established as the Australian centre of excellence in research and education in trauma care.

NTRI Director Professor Thomas Kossmann said the Alfred would be the first campus of the Institute, to promote collaborative, multi-disciplinary partnerships between major teaching and clinical organisations.

‘We will undertake research into brain and spinal trauma, computer-assisted surgery, trauma intensive care, emergency medicine, orthopaedics, radiology, epidemiology and rehabilitation,’ Professor Kossmann said.

‘We also hope that other NTRI campuses will be established around Australia in coming years, achieving a truly multi-centred, collaborative Institute.’

The project management team for the DECRA Trial, along with other trauma research projects, will move into the new NTRI premises in the Alfred Medical Research and Education Precinct, when they are completed in mid 2004.

‘As Australia’s busiest trauma centre, the Alfred is well-placed to provide a strong clinical base for research projects like the DECRA Trial,’ Prof Kossmann said.

Every three days someone presents to The Alfred with a severe brain injury.

Head injury is the most frequent injury received in major trauma presenting to the Alfred.

The number of people with an Acquired Brain Injury in Victoria is about 73,000.

Trauma is the leading cause of death for people under 44 years.

Doctors understand that when a patient receives a head injury the damage to the brain can continue for several days after the initial injury, through swelling and the release of chemicals.

This is called secondary brain injury.

If doctors can better understand how damage is developing, they can better target treatment during this crucial period.

Patients who have received a severe traumatic brain injury and are suitable for the DECRA Trial are enrolled, following discussions with their family, soon after arriving at the hospital.

The patients are randomly selected to receive either surgical or medical treatment.

Those who are selected for the surgical arm of the Study undergo a decompressive craniectomy procedure.

This procedure involves removing the top front section of the skull under general anaesthetic—a piece about 15–20 centimetres wide and five to 10 centimetres high. This gives the patient’s brain room to swell without cutting off the circulation of vital fluids and oxygen.

This section of bone is stored frozen for a period of six weeks to several months and is then put back into the patient’s head once the swelling has gone down.

The procedure leaves no visible surgical scars.

Patients in the medical arm of the study receive the current management practices, which include treatment with drugs, draining of fluid, ventilation and careful management of oxygen levels.

These treatments are all known to help reduce the amount of brain swelling.

All of the patients in the Study are assessed to see how the treatments have affected their recovery from the injury.

They undergo regular formal evaluation to determine how well their lives return to normal.

Chief Investigator of the study, Associate Professor Jamie Cooper said doctors know both the surgical and medical treatments can be safe and effective.

‘We don’t know which treatment is more effective, however.

‘We need to understand more about which of these treatments is better and which has the greatest impact on the patient’s quality of life following an accident,’ Associate Professor Cooper said.