June 20, 2018

Dr. Ivan Castro: Traumatic Brain Injuries in Work Comp

By Ivan Castro, MD, Medical Director, HomeCare Connect

Dr Ivan CastroWith the increase in workers compensation injuries, traumatic brain injury (TBI) is noted as the leading cause of long lasting disability, coma and death. The Center for Disease Control and Prevention (CDC) estimates that there were approximately 2.5 million cases and 50,000 deaths associated with TBI in 2010. TBI occurs as a result of head trauma from an external or penetrating force leading to structural and/or psychological brain disruption. Depending on the type of brain injury, the recovery process can take years, and in some instances, the injured worker may never recover motor or cognitive ability. Timely treatment is of the essence and any delays in medical treatment can result in costly, long and extensive forms of rehabilitation.

According to the CDC in 2013, falls are the leading cause of TBIs, accounting for approximately 35.2 percent. The second leading cause of TBIs are motor vehicle accidents, accounting for 17.3 percent. Due to the nature of many of auto accidents, they result in the highest percentage of TBI-related deaths according to the CDC. Other forms of TBI-related accidents according to the CDC include forms of being struck in the head, running into stationary objects, violence, inappropriate use of firearms, and assaults. Per the CDC (2012), men have a higher incidence of TBI; noted at 59 percent.

The specific degree of a TBI (mild, moderate, severe and catastrophic) is characterized by the severity of the symptoms caused by the insult and/or injury. When an injured worker presents to the Emergency Room with decreased responsiveness, their Glasgow Coma Scale (GCS) is measured to assess their neurological state and level of consciousness after head injury by measuring the conscious state of a person. Symptoms of TBI may include headache, dizziness, fatigue, blurry vision, short-term memory loss, difficulty focusing, ringing in the ears, depression, poor impulse control, and behavioral changes. The majority of TBI symptoms subside within a few days to weeks from date of injury. Approximately 15 percent of TBI patients do not recover within the first year of their injury. Most mild TBI injuries are often misdiagnosed as they are not capable of being detected on CT or MRI scans and go undetected for a long period of time. Moderate to severe TBI injuries may require surgery to reverse any signs of trauma- induced brain damage while preventing any further injury to the brain.

Depending on the severity of the injury and the permanent damage associated, the injured worker can become debilitated and unable to perform day-to-day functions at home and/or work. Appropriate treatment of a TBI may be extremely costly and complicated, encompassing diagnostic testing, medications, possible surgery, durable medical equipment, rehabilitation, and/or home/vehicle modifications. The recovery process can be life long and affect the injured worker’s physical, cognitive, and vocational and social well-being, resulting in adjustments and accommodations at home and/or work. Injured workers who have moderate to severe TBI may receive individually focused tailored rehabilitation programs consisting of, but not limited to, physical, occupational and speech therapy, social support and psychological and psychiatric treatment. Brain injuries typically mean significant lifestyle adjustments for injured workers and their families.

The cost of treating a injured worker with TBI can vary based on the extent of the injury. The National Institute for Neurological Disorders and Stroke conducted a study in 1989 and found that found that the lifetime cost of treatment for a single person with a TBI was more than $4 million. According to the CDC in 2010, the estimated economic costs of TBI was $76.3 billion, with $11.5 billion attributed to medical costs and $64.8 billion attributed to indirect costs of TBI, such as lost productivity. An injured worker can be in the hospital for a few days to a few weeks, where charges can range from $4,200 to $9,000 per day and if they are home receiving round-the-clock nursing care charges can range from $1,920 to $2,900 per day. More and more injured workers are going home to receive their care because of the familiarity of their homes and being around their family support system. Injured workers thrive in their own surroundings.

Patient education about TBI is key, and the sooner the injured worker is treated for a TBI, the quicker he/she begins the recovery process, and the less costly the claim becomes in the long run. The goal of transitioning injured workers to home is assist in safely functioning as independently as possible where they are comfortable and familiar. Home health services help provide TBI injured workers with the right support, where they can learn to adjust, and ultimately lead fulfilling lives. No one brain injury is the same and it is important to have the most accurate clinical assessment and level of care to meet the needs of the injured worker.

About Dr. Ivan Castro
As medical director for HomeCare Connect, Ivan D. Castro, MD oversees the company’s clinical programs and staff. He also works directly with treating physicians as needed to obtain the best medical outcomes for injured workers. Certified by the American Board of Internal Medicine, Dr. Castro has been treating workplace injuries and implementing wellness programs for more than 20 years. He is fluent in English and Spanish and maintains a private practice in Winter Park, Florida, near Orlando.

A graduate of Dartmouth College in New Hampshire, he earned his medical degree from the University of Illinois College of Medicine at Peoria in Illinois. Dr. Castro conducted his medical residency at the Alaska Area Native Health Service Mt. Edgecumbe Hospital in Sitka, Alaska and his residency in internal medicine at Kaiser Permanente Medical Center in Santa Clara, California. Orlando Magazine has named him “Top Doctor” in Internal Magazine numerous times, and he is the former chief of staff of the Winter Park Memorial Hospital.

About HomeCare Connect
HomeCare ConnectHomeCare Connect is a national ancillary network focused on workers’ compensation and providing home health, durable medical equipment and home modification services. The privately held company has a clinically driven model — from its 15,000+ credentialed provider network — to its highly experienced clinical staff who coordinate everything related to care, medical supplies and equipment delivered in the home. Services include catastrophic care and home health care along with durable medical equipment, supplies and home modifications. HomeCare Connect ensures the injured worker receives the right care, equipment and supplies from the right providers at the right time.

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