13 research outputs found
Variation in structure and process of care in traumatic brain injury : Provider profiles of European Neurotrauma Centers participating in the CENTER-TBI study
Funding Information: Data used in preparation of this manuscript were obtained in the context of CENTER-TBI, a large collaborative project with the support of the European Commission 7th Framework program (602150). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors would like to thank all CENTER-TBI investigators and their staff, who are listed below, for completing the provider profiling questionnaires. Authors would further like to thank Nada Andelic, Sasha Brazinova, Ruben van der Brande, Peter Cameron, Guiseppe Citerio, Ari Ercole, Thomas van Essen, Mathieu van der Jagt, Erwin Kompanje, Fiona Lecky, Joukje van der Naalt, David Nelson, Wilco Peul, Jukka Ranta, Cecilia Roe, Gerard Ribbers, Nino Stochetti, Olli Tenovuo and Lindsay Wilson for their help with the development of the provider profiling questionnaires. Publisher Copyright: Ā© 2016 Cnossen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Introduction: The strength of evidence underpinning care and treatment recommendations in traumatic brain injury (TBI) is low. Comparative effectiveness research (CER) has been proposed as a framework to provide evidence for optimal care for TBI patients. The first step in CER is to map the existing variation. The aim of current study is to quantify variation in general structural and process characteristics among centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Methods: We designed a set of 11 provider profiling questionnaires with 321 questions about various aspects of TBI care, chosen based on literature and expert opinion. After pilot testing, questionnaires were disseminated to 71 centers from 20 countries participating in the CENTER-TBI study. Reliability of questionnaires was estimated by calculating a concordance rate among 5% duplicate questions. Results: All 71 centers completed the questionnaires. Median concordance rate among duplicate questions was 0.85. The majority of centers were academic hospitals (n = 65, 92%), designated as a level I trauma center (n = 48, 68%) and situated in an urban location (n = 70, 99%). The availability of facilities for neuro-trauma care varied across centers; e.g. 40 (57%) had a dedicated neuro-intensive care unit (ICU), 36 (51%) had an in-hospital rehabilitation unit and the organization of the ICU was closed in 64% (n = 45) of the centers. In addition, we found wide variation in processes of care, such as the ICU admission policy and intracranial pressure monitoring policy among centers. Conclusion: Even among high-volume, specialized neurotrauma centers there is substantial variation in structures and processes of TBI care. This variation provides an opportunity to study effectiveness of specific aspects of TBI care and to identify best practices with CER approaches.publishersversionPeer reviewe
Postoperative survival in patients with multiple brain metastases
BACKGROUND AND OBJECTIVE: Although surgery is traditionally performed for patients with a single brain metastasis, an increasing number of patients with multiple brain metastases may also be treated surgically. The objective of the study was to analyze postoperative survival results and the clinical factors affecting these results. MATERIAL AND METHODS: The records of the patients who underwent surgical resection of 2 or more lesions between January 2005 and January 2010 were retrospectively reviewed. Survival was calculated from the date of surgery to the last follow-up evaluation or death, and different clinical factors were analyzed in regard to patient survival. RESULTS: In total, 36 patients underwent one or more craniotomies. The survival of the total group ranged from 16 days to 37.5 months (mean, 29 months). There were 4 deaths within 30 days. When divided into Radiation Therapy Oncology Group RPA classes, the survival time was 11.75, 8.58, and 5.31 months for classes 1, 2, and 3, respectively. Regarding an impact on the survival, a significant association with a favorable outcome was found for the following factors: the number of brain metastases (2-3 vs. 4-6, P=0.046), RPA classes (1 vs. 2 or 3, P=0.0192), and extent of metastasis resection (all vs. partial, P=0.018). CONCLUSIONS: Well-selected patients with multiple brain metastases appear to benefit from surgery compared with historical controls of patients treated with whole-brain radiotherapy alone.publishersversionPeer reviewe
Variation in Structure and Process of Care in Traumatic Brain Injury: Provider Profiles of European Neurotrauma Centers Participating in the CENTER-TBI Study.
INTRODUCTION: The strength of evidence underpinning care and treatment recommendations in traumatic brain injury (TBI) is low. Comparative effectiveness research (CER) has been proposed as a framework to provide evidence for optimal care for TBI patients. The first step in CER is to map the existing variation. The aim of current study is to quantify variation in general structural and process characteristics among centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. METHODS: We designed a set of 11 provider profiling questionnaires with 321 questions about various aspects of TBI care, chosen based on literature and expert opinion. After pilot testing, questionnaires were disseminated to 71 centers from 20 countries participating in the CENTER-TBI study. Reliability of questionnaires was estimated by calculating a concordance rate among 5% duplicate questions. RESULTS: All 71 centers completed the questionnaires. Median concordance rate among duplicate questions was 0.85. The majority of centers were academic hospitals (n = 65, 92%), designated as a level I trauma center (n = 48, 68%) and situated in an urban location (n = 70, 99%). The availability of facilities for neuro-trauma care varied across centers; e.g. 40 (57%) had a dedicated neuro-intensive care unit (ICU), 36 (51%) had an in-hospital rehabilitation unit and the organization of the ICU was closed in 64% (n = 45) of the centers. In addition, we found wide variation in processes of care, such as the ICU admission policy and intracranial pressure monitoring policy among centers. CONCLUSION: Even among high-volume, specialized neurotrauma centers there is substantial variation in structures and processes of TBI care. This variation provides an opportunity to study effectiveness of specific aspects of TBI care and to identify best practices with CER approaches
Variation in general supportive and preventive intensive care management of traumatic brain injury: a survey in 66 neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study
Abstract
Background
General supportive and preventive measures in the intensive care management of traumatic brain injury (TBI) aim to prevent or limit secondary brain injury and optimize recovery. The aim of this survey was to assess and quantify variation in perceptions on intensive care unit (ICU) management of patients with TBI in European neurotrauma centers.
Methods
We performed a survey as part of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. We analyzed 23 questions focused on: 1) circulatory and respiratory management; 2) fever control; 3) use of corticosteroids; 4) nutrition and glucose management; and 5) seizure prophylaxis and treatment.
Results
The survey was completed predominantly by intensivists (nā=ā33, 50%) and neurosurgeons (nā=ā23, 35%) from 66 centers (97% response rate).
The most common cerebral perfusion pressure (CPP) target was >ā60 mmHg (nā=ā39, 60%) and/or an individualized target (nā=ā25, 38%). To support CPP, crystalloid fluid loading (nā=ā60, 91%) was generally preferred over albumin (nā=ā15, 23%), and vasopressors (nā=ā63, 96%) over inotropes (nā=ā29, 44%). The most commonly reported target of partial pressure of carbon dioxide in arterial blood (PaCO2) was 36ā40 mmHg (4.8ā5.3 kPa) in case of controlled intracranial pressure (ICP) <ā20 mmHg (nā=ā45, 69%) and PaCO2 target of 30ā35 mmHg (4ā4.7 kPa) in case of raised ICP (nā=ā40, 62%). Almost all respondents indicated to generally treat fever (nā=ā65, 98%) with paracetamol (nā=ā61, 92%) and/or external cooling (nā=ā49, 74%). Conventional glucose management (nā=ā43, 66%) was preferred over tight glycemic control (nā=ā18, 28%). More than half of the respondents indicated to aim for full caloric replacement within 7 days (nā=ā43, 66%) using enteral nutrition (nā=ā60, 92%). Indications for and duration of seizure prophylaxis varied, and levetiracetam was mostly reported as the agent of choice for both seizure prophylaxis (nā=ā32, 49%) and treatment (nā=ā40, 61%).
Conclusions
Practice preferences vary substantially regarding general supportive and preventive measures in TBI patients at ICUs of European neurotrauma centers. These results provide an opportunity for future comparative effectiveness research, since a more evidence-based uniformity in good practices in general ICU management could have a major impact on TBI outcome
Variation in neurosurgical management of traumatic brain injury
Background: Neurosurgical management of traumatic brain injury (TBI) is challenging, with only low-quality evidence. We aimed to explore differences in neurosurgical strategies for TBI across Europe. Methods: A survey was sent to 68 centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. The questionnaire contained 21 questions, including the decision when to operate (or not) on traumatic acute subdural hematoma (ASDH) and intracerebral hematoma (ICH), and when to perform a decompressive craniectomy (DC) in raised intracranial pressure (ICP). Results: The survey was completed by 68 centers (100%). On average, 10 neurosurgeons work in each trauma center. In all centers, a neurosurgeon was available within 30Ā min. Forty percent of responders reported a thickness or volume threshold for evacuation of an ASDH. Most responders (78%) decide on a primary DC in evacuating an ASDH during the operation, when swelling is present. For ICH, 3% would perform an evacuation directly to prevent secondary deterioration and 66% only in case of clinical deterioration. Most respondents (91%) reported to consider a DC for refractory high ICP. The reported cut-off ICP for DC in refractory high ICP, however, differed: 60% uses 25Ā mmHg, 18% 30Ā mmHg, and 17% 20Ā mmHg. Treatment strategies varied substantially between regions, specifically for the threshold for ASDH surgery and DC for refractory raised ICP. Also within center variation was present: 31% reported variation within the hospital for inserting an ICP monitor and 43% for evacuating mass lesions. Conclusion: Despite a homogeneous organization, considerable practice variation exists of neurosurgical strategies for TBI in Europe. These results provide an incentive for comparative effectiveness research to determine elements of effective neurosurgical care
Postoperative Survival in Patients With Multiple Brain Metastases
Background and Objective. Although surgery is traditionally performed for patients with a single brain metastasis, an increasing number of patients with multiple brain metastases may also be treated surgically. The objective of the study was to analyze postoperative survival results and the clinical factors affecting these results. Material and Methods. The records of the patients who underwent surgical resection of 2 or more lesions between January 2005 and January 2010 were retrospectively reviewed. Survival was calculated from the date of surgery to the last follow-up evaluation or death, and different clinical factors were analyzed in regard to patient survival. Results. In total, 36 patients underwent one or more craniotomies. The survival of the total group ranged from 16 days to 37.5 months (mean, 29 months). There were 4 deaths within 30 days. When divided into Radiation Therapy Oncology Group RPA classes, the survival time was 11.75, 8.58, and 5.31 months for classes 1, 2, and 3, respectively. Regarding an impact on the survival, a significant association with a favorable outcome was found for the following factors: the number of brain metastases (2ā3 vs. 4ā6, P=0.046), RPA classes (1 vs. 2 or 3, P=0.0192), and extent of metastasis resection (all vs. partial, P=0.018). Conclusions. Well-selected patients with multiple brain metastases appear to benefit from surgery compared with historical controls of patients treated with whole-brain radiotherapy alone
Two and More Cerebral Metastases Complex Treatment Options. Doctoral Thesis
Promocijas darbs izstrÄdÄts RÄ«gas StradiÅa universitÄtes NeiroloÄ£ijas un neiroÄ·irurÄ£ijas katedras klÄ«niskajÄ bÄzÄ ā RÄ«gas Austrumu klÄ«niskÄs universitÄtes slimnÄ«cas (RAKUS) klÄ«nikÄ āGaiļezersā (nodaļas vadÄ«tÄji ā dr. K. BicÄns, prof. J. OzoliÅÅ” ) ā sadarbÄ«bÄ ar Latvijas OnkoloÄ£ijas centra TerapeitiskÄs radioloÄ£ijas un medicÄ«nas fizikas klÄ«niku (vadÄ«tÄja ā Dr. med. docente O. Utehina) un Staru terapijas nodaļu (vadÄ«tÄja ā Z. Liepa). RadioloÄ£iskÄ diagnostika un terapijas kontrole galvenokÄrt veikta RadioloÄ£ijas katedras klÄ«niskajÄ bÄzÄ ā RAKUS klÄ«nikÄ āGaiļezersā (vadÄ«tÄja ā profesore G. KrÅ«miÅa). EvakuÄto cerebrÄlo metastÄžu Ä£enÄtiskÄ analÄ«ze veikta sadarbÄ«bÄ ar RÄ«gas StradiÅa universitÄtes OnkoloÄ£ijas institÅ«tu (vadÄ«tÄjs ā profesors E. MiklaÅ”eviÄs). AizstÄvÄÅ”ana: 2015. gada 10. jÅ«nijÄ plkst. 15.00 RÄ«gas StradiÅa universitÄtes MedicÄ«nas promocijas padomes atklÄtÄ sÄdÄ RÄ«gÄ, Dzirciema ielÄ 16, HipokrÄta auditorijÄ.Promocijas darbs ir veltÄ«ts vienai no aktuÄlÄkajÄm mÅ«sdienu neiroÄ·irurÄ£ijas un onkoloÄ£ijas problÄmÄm ā vÄža cerebrÄlu metastÄžu ÄrstÄÅ”anas taktikai, kÄ arÄ« iespÄjÄm uzlabot ÄrstÄÅ”anas rezultÄtus ar jaunÄkajiem pieejamajiem resursiem. CerebrÄlÄs metastÄzes ir visbiežÄk sastopamais intrakraniÄlo audzÄju veids. Uzlabojoties ekstrakraniÄlÄs patoloÄ£ijas ÄrstÄÅ”anas rezultÄtiem un kļūstot pieejamÄkiem neiroradioloÄ£iskiem izmeklÄjumiem, diagnosticÄto cerebrÄlo metastÄžu skaitam ir tendence pieaugt. PaÅ”reiz, arÄ« LatvijÄ, cerebrÄlu metastÄžu ÄrstÄÅ”anÄ ir iespÄjams pielietot jaunÄkÄs ÄrstÄÅ”anas metodes: Ä·irurÄ£isku rezekciju, stereotaktisku radioÄ·irurÄ£iju, visu galvas smadzeÅu apstaroÅ”anu (WBRT) un Ä·Ä«mijterapiju. Ja pacientam ir viena cerebrÄla metastÄze, ÄrstÄÅ”anas taktika parasti ir standartizÄta un tÄ ir maksimÄli radikÄla, iekļaujot kompleksas terapijas pielietojumu. Slimniekiem ar divÄm un vairÄkÄm cerebrÄlÄm metastÄzÄm lÄ«dz Å”im vÄl nav atrodamas skaidras indikÄcijas Ä·irurÄ£iskai un kompleksai terapijai. MÅ«su pÄtÄ«juma mÄrÄ·is bija izanalizÄt un savstarpÄji salÄ«dzinÄt divu un vairÄku galvas smadzeÅu metastÄžu Ä·irurÄ£iskas un kombinÄtas ÄrstÄÅ”anas iespÄjas un rezultÄtus, kÄ arÄ« izvÄrtÄt pirmos galvas smadzeÅu metastÄžu radioÄ·irurÄ£iskÄs ÄrstÄÅ”anas rezultÄtus LatvijÄ. RetrospektÄ«vÄ pÄtÄ«jumÄ tika analizÄti dati par 40 pacientiem, kuri ÄrstÄti Ä·irurÄ£iski (14 no tiem pÄcoperÄcijas periodÄ saÅÄma kompleksu terapiju), un LatvijÄ pirmajiem 16 radioÄ·irurÄ£isku terapiju saÅÄmuÅ”iem pacientiem, kuri ÄrstÄti RÄ«gas Austrumu klÄ«niskÄs universitÄtes slimnÄ«cas klÄ«niskajÄs bÄzÄs laika periodÄ no 2005. lÄ«dz 2012. gadam. Tika vÄrtÄti pacientu ÄrstÄÅ”anas rezultÄti un dzÄ«vildze atkarÄ«bÄ no klÄ«niskajiem un radioloÄ£iskajiem kritÄrijiem un pielietotÄs ÄrstÄÅ”anas taktikas, kÄ arÄ« veikta visu evakuÄto cerebrÄlo metastÄžu Ä£enÄtiskÄ materiÄla analÄ«ze klÄ«niski nozÄ«mÄ«gu TP53 gÄna mutÄciju noteikÅ”anai. Datu apstrÄde tika veikta, izmantojot datorprogrammas IBM SPSS v.21. Darba rezultÄtÄ noskaidrots, ka divu un vairÄku galvas smadzeÅu metastÄžu Ä·irurÄ£iska evakuÄcija ļauj pagarinÄt dzÄ«vildzi un saglabÄt pacienta funkcionÄlo stÄvokli noteiktu laika intervÄlu pÄc operÄcijas. LabÄki divu un vairÄku cerebrÄlu metastÄžu Ä·irurÄ£iskas ÄrstÄÅ”anas rezultÄti iegÅ«ti pacientu grupai ar 2ā3 metastÄzÄm pÄc radikÄlas un totÄlas visu diagnosticÄto mezglu evakuÄcijas. Statistiski nozÄ«mÄ«ga ietekme uz labÄku dzÄ«vildzes prognozi postoperatÄ«vi ir Å”Ädiem faktoriem: metastÄžu skaitam, radikÄlai metastÄžu evakuÄcijai, pirmsoperÄcijas KPS un RPA klases rÄdÄ«tÄjiem. DzÄ«vildzes prognoze pacientiem ar oligometastÄzÄm (mediÄnÄ dzÄ«vildze ā 5,5 mÄneÅ”i) ir 2,66 reizes garÄka, salÄ«dzinot ar pacientiem, kuriem ir multiplas cerebrÄlÄs metastÄzes (mediÄnÄ dzÄ«vildze ā 2,06 mÄneÅ”i) (p < 0,05). Kompleksas terapijas (WBRT vai WBRT un Ä·Ä«mijterapijas) pielietojums parciÄlas smadzeÅu metastÄžu evakuÄcijas gadÄ«jumÄ dod nelielu dzÄ«vildzes pagarinÄjumu salÄ«dzinÄjumÄ ar daļÄju, tikai Ä·irurÄ£isku metastÄžu evakuÄciju. Pirmo 16 LatvijÄ radioÄ·irurÄ£iski ÄrstÄto pacientu izvÄrtÄjums, kuriem bija nelielas (lÄ«dz 3 cm diametrÄ) cerebrÄlÄs metastÄzes, uzrÄda pozitÄ«vus rezultÄtus, kuri prasa tÄlÄkus pÄtÄ«jumus un analÄ«zi. HistoloÄ£iskÄ materiÄla Ä£enÄtiskajÄ analÄ«zÄ (11 novÄrojumos no 40) tika konstatÄtas klÄ«niski nozÄ«mÄ«gas TP53 gÄna mutÄcijas. Statistiski nozÄ«mÄ«ga ietekme starp pÄcoperÄcijas dzÄ«vildzi un TP 53 gÄna mutÄcijÄm pÄtÄ«jumÄ netika konstatÄta. VeiktÄ darba rezultÄtÄ tika izstrÄdÄtas praktiskÄs rekomendÄcijas ÄrstÄÅ”anas taktikas izvÄlei slimniekam ar divÄm un vairÄkÄm cerebrÄlÄm metastÄzÄm.Promocijas darbs veikts ar Eiropas sociÄlÄ fonda projekta āAtbalsts doktorantiem studiju programmas apguvei un zinÄtniskÄ grÄda ieguvei RÄ«gas StradiÅa universitÄtÄā finansiÄlu atbalstu
Divu un vairÄku cerebrÄlu metastÄžu kompleksas ÄrstÄÅ”anas iespÄjas. Promocijas darba kopsavilkums
Doctoral Thesis was carried out at the clinical basis of RÄ«ga StradiÅÅ” University Department of Neurology and Neurosurgery ā Riga East Clinical University Hospital (RECUH) Clinical Centre āGaiļezersā (Heads of Department Dr. K. BicÄns, Professor J. OzoliÅÅ” ) ā in cooperation with Latvian Oncology Centre Clinic of Therapeutic Radiology and Medical Physics (Head of Clinics, Ph. D. , Assistant Professor O. Utehina) and Radiation Therapy Department (Head Z. Liepa). Diagnostic radiology and control of therapy was mostly performed at the clinical base of Radiology Department ā RECUH Clinical Centre āGaiļezersā (Head Professor G. KrÅ«miÅa). Genetic analysis of evacuated cerebral metastases was performed in collaboration with RÄ«ga StradiÅÅ” University Institute of Oncology (Head Professor E. MiklaÅ”eviÄs). Defence: at the public session of the Doctoral Committee of Medicine on 10 June 2015 at 15.00 in Hippocrates Lecture Theatre, 16 Dzirciema Street, RÄ«ga StradiÅÅ” University.The title of the doctoral thesis is Combined Therapy Options of One or More Cerebral Metastases . The doctoral theses is devoted to one of the most topical problems in the field of modern neurosurgery and oncology ā treatment tactics in case of cerebral cancer metastases and possibilities to improve treatment outcomes using most recent available resources. Cerebral metastases are the most common type of intracranial tumors. As a result of improved extracranial pathology therapy outcomes and increased availability of neuroradiology examinations, the number of diagnosed cerebral metastases is tended to be increased. Now, also in Latvia, it is possible to use most recent therapeutic methods for the treatment of cerebral metastases: surgical resection, stereotactic radiosurgery, whole brain radiotherapy (WBRT) and chemotherapy. For patients with one cerebral metastasis, treatment tactics are usually standardized and is radical as possible including surgery and administration of complex therapy. In patients with two or more cerebral metastases clear indications for surgical and complex therapy cannot yet be found. The aim of our study was to analyse and compare possibilities and results of surgical and combined treatment in cases with two or more cerebral metastases and to evaluate first results of radiosurgical cerebral metastases treatment in Latvia. In the retrospective study were analysed data of 40 surgically-treated patients (including 14 patients receiving complex treatment in postoperative period) and first 16 patients in Latvia who received stereotactic radiosurgery therapy and radiotherapy; patients were treated at clinical centres of Riga East Clinical University Hospital during the time period from year 2005 to 2012. The therapy outcomes and survival in relation to clinical and radiological criteria and applied tactics for the treatment were evaluated, as well as analysis of genetic material of the evacuated cerebral metastases for determination of clinically significant mutation of gene TP53. A specialized software ā IBM SPSS v.21ā was used for data processing. As derived at the conclusion of the work the surgical evacuation of two or more cerebral metastases during a specified interval of time following the surgery allows to increase survival time and to maintain patientās functional status. The best results of the surgical treatment of two or more cerebral metastases were obtained in the group of patients with 2ā3 metastases after radical and total evacuation of all diagnosed cancer cerebral metastases. A statistically significant influence to a better prognosis of post-operative survival time show the following factors: number of metastases, radical evacuation of metastases, pre-operative KPS and RPA class indicators. Prognosis of survival in patients with oligometastases (median survival ā 5.5 months) is 2.66 times longer than in patients with multiple cerebral metastases (median survival is 2.06 months) (p < 0.05). Administration of complex therapy (WBRT or WBRT and chemotherapy) in case of partial evacuation of cerebral metastases ensures a slightly prolonged survival time in comparison with cases of only partial surgical evacuation of metastases. Assessment of first 16 patients with small cerebral metastases (in diameter up to 3 cm) treated with radiosurgery in Latvia produce positive results requiring further research and analysis. Under genetic analysis of histological material (11 observations out of 40) there were established clinically significant mutations of gene TP53. No statistically significant influence between the post-operative survival ratio and mutations of gene TP53 was established during the study. As a result of the work there were developed practical recommendations on the choice of treatment tactics for patients with two or more cerebral metastases.Doctoral thesis was carried out with a financial support of European Social Fund project āFinancial support for doctoral students for acquisition of study program and obtaining of scientific degree qualification at RÄ«ga StradiÅÅ” Universityā
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Biomarkers for Traumatic Brain Injury: Data Standards and Statistical Considerations
Recent biomarker innovations hold potential for transforming diagnosis, prognostic modeling, and precision therapeutic targeting of traumatic brain injury (TBI). However, many biomarkers, including brain imaging, genomics, and proteomics, involve vast quantities of high-throughput and high-content data. Management, curation, analysis, and evidence synthesis of these data are not trivial tasks. In this review, we discuss data management concepts and statistical and data sharing strategies when dealing with biomarker data in the context of TBI research. We propose that application of biomarkers involves three distinct steps-discovery, evaluation, and evidence synthesis. First, complex/big data has to be reduced to useful data elements at the stage of biomarker discovery. Second, inferential statistical approaches must be applied to these biomarker data elements for assessment of biomarker clinical utility and validity. Last, synthesis of relevant research is required to support practice guidelines and enable health decisions informed by the highest quality, up-to-date evidence available. We focus our discussion around recent experiences from the International Traumatic Brain Injury Research (InTBIR) initiative, with a specific focus on four major clinical projects (Transforming Research and Clinical Knowledge in TBI, Collaborative European NeuroTrauma Effectiveness Research in TBI, Collaborative Research on Acute Traumatic Brain Injury in Intensive Care Medicine in Europe, and Approaches and Decisions in Acute Pediatric TBI Trial), which are currently enrolling subjects in North America and Europe. We discuss common data elements, data collection efforts, data-sharing opportunities, and challenges, as well as examine the statistical techniques required to realize successful adoption and use of biomarkers in the clinic as a foundation for precision medicine in TBI
Variation in neurosurgical management of traumatic brain injury: a survey in 68 centers participating in the CENTER-TBI study (vol 161, pg 453, 2019)
The collaborator names are inverted.status: publishe