1. Albany VAMC Polytrauma Clinic February 25, 2009 Barbara Bates, MD, MBA

2. Defining “Polytrauma” 2 or more injuries to physical regions or organ systems, one of which may be life threatening  Traumatic brain injury (TBI)  Limb Amputation  Spinal Cord Injury (SCI)  Visual or Hearing Impairments  Burns/wounds  Psychological trauma (PTSD)  Fractures

3. VHA Directives Established tiered system of care  Component 1: 4 Regional Centers  Component 2: 21 Polytrauma Network Sites Network 2 site: Syracuse  Component 3: Polytrauma Support Clinics  Component 4: Polytrauma Points of Contact Established process for TBI screening

4. Role of the Polytrauma Support Clinic Integrated specialty care Case Management Consultative services within the designated staff’s expertise

5. Albany Team Social Work Physiatry Psychiatry Neuropsychology Psychology Music Therapy Speech Language Pathology

6. Team process Clinic meets weekly Patient evaluated by Physiatrist and Social worker Case discussed at team conference and treatment plan implemented Follow-up depends on needs of patient

7. TBI screening tool 4 sections  Events  Immediate symptoms following events  New/worsening symptoms following events  Current symptoms Positive screen Consult Polytrauma team

9. Second Level TBI Screen: Feeling dizzy Loss of balance Poor coordination, clumsy Headaches Nausea Vision problems, blurring, trouble seeing Sensitivity to light Hearing difficulty Sensitivity to noise Numbness or tingling on parts of my body Change in taste and/or smell Loss of appetite or increase appetite Poor concentration, can't pay attention, easily distracted Forgetfulness, can't remember things Difficulty making decisions Slowed thinking, difficulty getting organized, can't finish things Fatigue, loss of energy, getting tired easily Difficulty falling or staying asleep Feeling anxious or tense Feeling depressed or sad Irritability, easily annoyed Poor frustration tolerance, feeling easily overwhelmed by things

10. Clinic TBI Stats (as of 11/30/08) 210 initial positive screens  128 patients have been evaluated in clinic  Most common reasons for consult cancellations: no response from patient patient not interested too far to travel active duty status

11. Patient population 18% confirmed TBI diagnosis 64.1% TBI diagnosis ruled out 18% TBI diagnosis uncertain

12. Symptom overlap between PTSD TBI Depression

13. TBI and PTSD  >50% of patients screening negative for TBI have diagnosis of PTSD  90% of patients with possible mild TBI also have diagnosis of PTSD  70% of patients with clear diagnosis of mild/moderate TBI have diagnosis of PTSD *Evidence of PTSD defined by: service connection for PTSD or enrolled in treatment for PTSD

14. Treatment: focus on function Memory aids Sleep hygiene Pain management

15. Other Diagnoses seen in Polytrauma clinic Spinal Cord Injury Amputation Multiple fractures/injuries Blindness

16. Future plans New staff: Pain management Develop psychiatry resident rotation Expand cognitive rehabilitation programming Integrate Audiology in to program Expand telemedicine