Division of Neurosurgery

Department of Surgery

Neurotrauma and Injury Prevention Programs

Treating and preventing traumatic brain injuries

Neurosurgeon 
Dr. David Clarke

Neurosurgeon                                
Dr. Simon Walling

Research manager                        
Lynne Fenerty

Research coordinators             
Lorelei Audas

Research Associate
Nelofar Kureshi

Team members

Dr. David Clarke, Neurosurgery
Dr. Simon Walling, Neurosurgery
Lynne Fenerty, program manager
Lorelei Audas, research coordinator
Nelofar Kureshi, data management
Coralea Carey, Research Assistant

Team collaborators

Department of Emergency Medicine
Department of Physical Medicine and Rehabilitation
Department of Critical Care
Emergency Health Services
Trauma Nova Scotia
Atlantic Collaborative for Injury Prevention
Department of Health Promotion and Protection
Parachute (ThinkFirst) Canada

Neurotrauma continues to be a leading cause of death and disability in Nova Scotia. The number of major trauma cases provincially continues to increase annually.  Nova Scotians suffer major trauma at a rate of 1 per 1000 people; among those, 40% are afflicted with a serious traumatic brain injury (TBI). The most common mechanisms of injury are falls (44%) and motor vehicle crashes (27%). Ongoing surveillance demonstrates that there are significant regional variations in the prevalence of major TBI in the province.

The annual economic burden of traumatic injury in Canada and Nova Scotia is estimated at $26.8 billion and $790 million respectively. The human cost for patients and families suffering traumatic brain injury (TBI) is tremendous, and is particularly tragic given that up to 95% of injuries have a preventable component.

The Neurotrauma and Injury Prevention programs are dedicated to improving traumatic brain injury (TBI) care for patients and families across the spectrum of injury, with an emphasis on knowledge translation.  The programs collaborate across multiple sectors to deliver targeted, evidence-based injury prevention and clinical programming for TBI care.

Mission

  • Provide leadership in injury prevention and neurotrauma research, advocacy, education and knowledge translation
  • Collaborate with multi-sectorial partners to design and deliver targeted injury prevention strategies and trauma system improvements

Goals

  • Develop evidence-based care pathways to accelerate access to neurosurgical care, reduce lengths of stay and optimize patient outcomes
  • Provide excellence in injury prevention programming and education through an evidence-based approach
  • Support advocacy efforts and enhancement of service provision throughout the spectrum of injury, across the continuum of care from prevention to the community

Accomplishments

  • In partnership with the Nova Scotia Rehabilitation Centre, a telephone follow-up program has been implemented for TBI patients discharged from the neurosurgical unit. A phone interview shortly after discharge provides assessment and support for TBI patients in the community
  • In collaboration with the Neurosurgery Quality Committee, an evidence-based clinical care pathway for TBI patients is under development
  • We are working closely with Case Costing (NSHA-Central Zone) to capture neurotrauma-related OR costs
  • The Government of Nova Scotia is developing the province’s first acquired brain injury (ABI) Strategy.   Along with the Department of Health and Wellness, multidisciplinary service providers, and brain injury survivors, we are members of the working group for the development of this strategy
  • In a partnership with the Division of Physical Medicine and Rehabilitation, Department of Family Medicine, and the Department of Emergency Medicine, we are working to develop a multi disciplinary concussion clinic
  • We have partnered with medical students at Dalhousie University for the implementation of “Concussion U”, a concussion interest and education group founded by medical students
  • A Concussion Nova Scotia resource website is being launched.  The website will provide a clinical toolkit for concussion management as well as resources for patients and families

Research

• All TBI cases admitted to the QEII are reviewed at weekly TBI teaching rounds, chaired by Dr. Clarke. Over 2000 cases have been reviewed to date for inclusion in the TBI database, as well as for quality improvement purposes

• A retrospective chart review comparing outcomes for different approaches in the management of chronic subdural hematomas has been completed and is in the manuscript preparation phase

• A multivariate regression analysis has been completed examining their influence of multiple factors on expeditious access to tertiary care. A manuscript is currently in preparation

• We are members of the Canadian Traumatic Brain Injury Research and Clinical Network, a partnership of Canadian basic and clinician scientists focused on TBI research. Within this group, we are members of the Network’s Health Care Utilization Task Force, which will use national administrative datasets to examine TBI patients’ usage of health care resources

• Data from the Quantitative Analysis of Ski and Snowboard Helmet use in Nova Scotia study have resulted in the implementation of the first all-ages Snowsport helmet legislation in the world, resulting in a 100% legislation compliance rate across all ages and ski hills in NS. A manuscript for the longitudinal overview of this novel public policy approach is in press in the journal Injury Prevention

• In partnership with the Department of Health and Wellness and the Nova Scotia Trauma Program, we have undertaken an investigation of the incidence and economic burden of alcohol-related traumatic brain injury in Nova Scotia