Randall M. Chesnut, M.D.
Professor
Director of Cranial and
Spinal Trauma Center at HMC

Dr. Randall Chesnut is a Professor of Neurological Surgery at the University of Washington School of Medicine, and holds a joint appointment as Professor in Orthopaedics and Sports Medicine. In addition to his duties as an attending neurosurgeon at Harborview Medical Center and the University of Washington Medical Center, he serves as Director of Brain and Spine Injury Services in the Department of Neurological Surgery.

Dr. Chesnut received his medical degree from the University of Washington in 1984. He completed a five-year neurosurgery residency at the University of California, San Diego, followed by a one-year spine fellowship in their Department of Orthopaedics, under Professors Steven Garfin, Vert Mooney and Dr. JJ Abitbol. He joined their department as Assistant Professor in Residence from 1990-1994. In 1994, he was appointed Chief of Neurosurgical Services at San Francisco General Hospital (San Francisco, California).

In 1996, Dr. Chesnut accepted the position of Associate Professor of Neurosurgery and Director of Neurotrauma and Neurologic Critical Care at Oregon Health Sciences University in Portland, Oregon and served in that capacity until 2004, when he accepted the position of Director of Brain and Spine Injury Services at the University of Washington Department of Neurological Surgery.

Patient Care:

Dr. Chesnut’s clinical practice focuses on:

• Surgical and critical care management of acute traumatic brain injury.
• Surgical and critical care management of acute spinal cord and spinal column injuries.
• Sports-related spinal cord and spinal comumn injuries with an interest toward early return to play.
• Failed spinal surgery.
• Adult spinal deformity.

Research:

Dr. Chesnut’s research interests are:

• Brain injury and trauma care systems in developing countries.
• Prospective investigations of outcome from acute brain injury in adults and children in developing countries (Cuba and Argentina)
• Early mobilisation from acute spinal column injuries.
• Targetted therapy in the management of traumatic brain injury.
• Evidence based medicine in traumatic brain injury management and spine surgery.

Education and Training:

1976 University of Washington B.S., Biology,

1976 University of Washington B.S., Psychology,

1984 University of Washington M.D.

1984-1985 Intern, General Surgery ,
Department of Surgery
University of Washington

1985-1989 Resident, Neurosurgery,
Department of Surgery, Division of Neurosurgery
University of California, San Diego

1989-1990 Chief Resident, Neurosurgery,
Department of Surgery, Division of Neurosurgery
University of California, San Diego

1990-1991 Clinical Fellow in Spine Surgery,
Department of Surgery,
Division of Orthopedics
University of California, San Diego

Honors and Awards:

1971 Phi Theta Honor Society - Listed in Merit's Who's Who of American High School Students

1972 National Merit Scholar Finalist

1989 Volvo Award on Central Nervous System Injury Research, International Congress of Neurosurgical Societies

1990 Curtis Visiting Professor in Surgery at Dartmouth Medical College

1991 Poster Award, Section on Head Injury/Control of ICP, Eighth International Symposium on Intracranial Pressure
Rotterdam, The Netherlands

1996 Recipient of the Brain Injury Association's Sheldon Berol Clinical Service Award

Recent Research Grants:

07/02 - ongoing: Oregon TBI Model Systems Study

Project 1: The effect of services by a community resource advocate on long term recovery in TBI
Project 2: Forming collaborative partnerships with families effected by brain injury
Project 3: The effect of medical benefit payment of outcome on TBI
Project 4: Accessibility of health resources to survivors of TBI in urban and rural environments
Project 5: Therapeutic Intensity Level
Project 6: Bob Brown Scale

07/02 - ongoing: Argentina Project Study
Traumatic Brain Injury Rehabilitation

07/1/02 – 06/30/07 PI: Nancy Temkin, PhD
U01 HD426 53
NIH NCMRR
Cooperative Multicenter TBI Clinical Trials Network
One of up to eight centers nationwide to collect longitudinal data on people with traumatic brain injury and, with separate funding, conduct clinical trials on interventions to improve the treatment and outcome of people sustain a traumatic brain injury.

11/01/03-10/31/06 R21 TW006724
NIH Fogarty International Center
“Pediatric Traumatic Brain Injury in Latin America”
Major Goals: This is a pilot project with pediatric TBI patients in seven trauma hospitals in Argentina. We will provide the treatment guidelines using two methods, and will evaluate the effect of the methods on practice and outcomes. In doing so, we will establish an infrastructure on a small scale that will become the prototype for the Latin American Brain Injury Consortium.

04/1/06 – 01/01/08 In-house sponsored study
Co-investigator
Prospective study involving recover outcomes for subjects via conservative versus surgical treatment of Lumbo-Sacral Stenosis using the Step Activity Monitor. The goal of this study is to follow patient with stenosis for a short period of time using the SAM which gives accurate record of the number of steps taken in a given time period.

04/1/06 – 01/1/2010 AOSpine North America
Co-Investigator
An observational study comparing surgical to conservative management in the treatment of Type II Odontoid fractures among the elderly. This is a two year prospective outcomes study comparing data on subject populations among ten institutions throughout the country on Type II Odontoid fractures and their treatment. This study also has a retrospective arm as well.

04/1/06 – 01/1/2010 AOSpine North America
Co-Investigator
An observational assessment of surgical treatment for treating Cervical Spondylotic Myelopathy (CSM). This a one year prospective outcomes study comparing data on subject populations among ten institutions throughout the country on CSM subjects and their treatment. This study also has a retrospective arm as well.

05/01/06 – 04/30/07 IDE# G050063 - Protocol DRS-05-001
Confluent Surgical Spinal Sealant System Study
A prospective, multi-center, randomized controlled study to compare the Spinal Sealant System as an adjunct to saturated dural repair with standard of care during spinal surgery.

03/14/07 – 02/28/08 DS3-06-002 (Chesnut)
Spinal Sealant Duradapt
A prospective, multi-center, randomized controlled study to compare the Spinal Sealant System as an adjunct to sutured dural repair with standard care methods during spinal surgery.

04/10/07 – 03/30/09 DRS-05-002 (Chesnut)
DuraSeal Sealant Post Market Study.
A prospective, multi-center, randomized controlled study to compare the Spinal Sealant system as an adjunct to sutured dural repair with standard of care methods during spinal surgery.

07/15/07–4/1/2012 R011NS058302-01 (Chesnut)
NIH R01
Tramatic Brain Injury in Latin America: Lifespan Analysis
This application is to establish a network of Centers of Excellence in Latin America that will, in collaboration with U.S. partners, conduct TBI research and training programs. The purpose is to identify factors that influence outcomes in resource-poor environments as well as teach the full spectrum of clinical research about TBI including care for TBI patients; the creation of the capacity for cognitive evaluation of TBI patients; education in data collection, management, analysis, interpretation, and the management of a data center; and education on how to identify, prepare and successfully apply for funding for future research projects.

10/1/07–09/30/2012 RO1 NS052478 (Chesnut, Co-Investigator)
Pediatric Hypothermia Trial
This study seeks to prove the hypothesis that treatment with moderate hypothermia (HYPO) will primarily improve mortality, and secondarily, improve global and neurocognitive outcome in children following severe traumatic brain injury (TBI).

Selected Publications:

Manuscripts -

1. Chesnut RM: Should we be using evidence-based quality assurance benchmarks to choose brain injury management centers?  Crit Care Med. 30: 1927-9, 2002.


2. Adelson P, Bratton S, Carney N, Chesnut R, du Coudray H, Goldstein B, Kochanek P, Miller H, Partington M, Selden N, Warden C, Wright D: Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Journal of Trauma 54: 235-310, Jun 2003.


3. Adelson P, Bratton S, Carney N, Chesnut R, du Coudray H, Goldstein B, Kochanek P, Miller H, Partington M, Selden N, Warden C, Wright D: Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Pediatr Crit Care Med 4(3)Suppl S1-S75, July 2003.


4. Chesnut RM: Management of brain and spine injuries.  Crit Care Med.  20:25-55, 2004.


5. Rondina C, Videtta W, Petroni G, Lujan S, Schoon P, Mori LB, Matkovich J, Carney N, Chesnut R: Mortality and morbidity from moderate to severe traumatic brain injury in Argentina.  J Head Trauma Rehabil.  20:368-76, 2005.


6. Vavilala MS, Muangman S, Tontisirin N, Fisk D, Roscigno C, Mitchell P, Kirkness C, Zimmerman JJ, Chesnut RM, Lam AM: Impaired cerebral autoregulation and 6-month outcome in children with severe traumatic brain injury: preliminary findings. Dev Neurosci. 28:348-53, 2006.


7. Barker L, Anderson J, Chesnut R, Nesbit G, Tjauw T, Hart R: Reliability and reproductability of dens fracture classification with use of plain radiography and reformatted computer-aided tomography.   J Bone Joint Surg Am 88:106-12, Jan 2006.


8. Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, Servadei F, Walters BC, Wilberger JE: Guidelines for the Surgical Management of Traumatic Brain Injury. Neurosurgery 58(3) S2-62, Mar 2006.


9. Chesnut RM: The evolving management of traumatic brain injury: Don’t shoot the messenger.  Crit Care Med. 34:2262, Aug 2006.


10. Tontisirin N, Armstead W, Waitayawinyu P, Moore A, Udomphorn Y, Zimmerman JJ, Chesnut R, Vavilala MS: Change in Cerebral Autoregulation as a Function of Time in Children Children after Severe Traumatic Brain Injury: A Case Series.  Childs Nerv Syst. 2007  Oct;23 (10):1163-9.  Epub April 2007.


11. Vavilala MS, Tontisirin N, Udomphorn Y, Armstead W, Zimmerman JJ, Chesnut R, Lam AM: Hemispheric Differences in Cerebral Autoregulation in Children with Moderate and Severe Traumatic Brain Injury.  Neurocrit Care. Dec 2007.

Book Chapters -

1. Chesnut RM: Treating raised Intracranial Pressure in head injury. In Narayan RK, et al (eds): Neurotrauma. New York: McGraw-Hill, Inc. 1996; pp 445-470.
   
   
2. Adelson P, Bratton S, Carney N, Chesnut R, du Coudray H, Goldstein B, Kochanek P, Miller H, Partington M, Selden N, Warden C, Wright D: Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Pediatr Crit Care. 3: S2-4, 2003. Chapters 1-17:
   
   Chapter 1: Introduction.
   Chapter 2: Trauma systems, pediatric trauma centers, and the neurosurgeon.
   Chapter 3. Prehospital airway management.
   Chapter 4. Resuscitation of blood pressure and oxygenation and prehospital brain-specific therapies for the severe pediatric traumatic brain injury patient.
   Chapter 5. Indications for intracranial pressure monitoring in pediatric pateitnts with severe traumatic brain injury.
   Chapter 6. Threshold for treatment of intracranial hypertension.
   Chapter 7. Intracranial pressure for monitoring technology.
   Chapter 8. Cerebral perfusion pressure.
   Chapter 9. Use of sedation and neuromuscular blockade in the treatment of severe pediatric traumatic brain injury.
   Chapter 10. The role of cerebrospinal fluid drainage in the treatment of severe pediatric traumatic brain injury.
   Chapter 11. Use of hypersmolar therapy in the management of severe pediatric traumatic brain injury.
   Chapter 12. Use of hyperventilation in the acute management of severe pediatric traumatic brain injury.
   Chapter 13. The use of barbiturates in the control of intracranial hypertension in severe traumatic brain injury.
   Chapter 14. The role of temperament control following severe pediatric brain injury.
   Chapter 15. Surgical treatment of pediatric intracranial hypertension.
   Chapter 16. The use of cortcosteroids in the treatment of severe pediatric traumatic brain injury.
   Chapter 17. Critical pathway for the treatment of established intracranial hyprtension in pediatric traumatic brain injury.
   
   
3. Book chapter, Essentials of Neuroanaesthesia and Critical Care, edited by Arun Gupta; 2006.
   
   
4. Chesnut, RM. Management of Incidental Durotomies and CSF Leaks. AOSpine Manual Clinical Applications (Vol 2), 2007; pp 695-712.
   
   
5. Chesnut, RM: Care of Central Nervous System Injuries. Surgical Clinics ofNorth America 87:119-
   156, 2007.
   
   
6. Chesnut RM. Scientific Surgical Management of Traumatic Brain Injury. In: Jallo J, Loftus, CM,
   eds. Neurotrauma & Critical Care: Brain. New York, NY: Thieme; In Press.

Letters to the Editor -

Chesnut RM: ICP monitoring, outcome from brain injury, and the National Enquirer. Letter to the Editor. Journal of Trauma (In press) 2008.

Contact Information

Patient Services:
Phone- 206-744-9300
Fax- 206-744-9944


Academic Office:
Phone- 206-744-9322
Fax- 206-744-9942

E-mail:
chesnutr@u.washington.edu

Mailing Address:
Harborview Medical Center
UW Medicine, Dept. of Neurosurgery
325 Ninth Avenue,
Box 359924
Seattle, WA 98104-2499

Clinic Location:
Patricia Bracelin Steel Memorial Building
Neurosurgery Clinics
401 Broadway - 2nd floor
Seattle, WA 98122