Advancing care for traumatic brain injury : findings from the IMPACT studies and perspectives on future research

Abstract

Research in Traumatic Brain Injury (TBI) is challenging because of many differences between patients. Advances in basic science have failed to translate into successful clinical treatments and the evidence underpinning guideline recommendations is low. Clinical research has been hampered by lack of standardized data collection, limited multidisciplinary collaboration and by insensitive approaches to classification and efficacy analyses. Multidisciplinary collaborations are now being fostered. Approaches for dealing with heterogeneity have been developed by the IMPACT study group. These can increase statistical power in clinical trials by up to 50% and are also relevant to other heterogeneous neurological diseases, such as stroke and subarachnoid hemorrhage. Rather than trying to limit heterogeneity, we may also be able to exploit it by analyzing differences in treatment and outcome between countries and centers in comparative effectiveness designs. This concept offers an additional research approach with great potential to advance the care in TBI