Traumatic brain injury: progress and challenges in prevention, clinical care, and research

A.I.R. Maas; D.K. Menon; G.T. Manley; M. Abrams; C. Akerlund; N. Andelic; M. Aries; T. Bashford; M.J. Bell; Y.G. Bodien; B.L. Brett; A. Buki; R.M. Chesnut; G. Citerio; D. Clark; B. Clasby; D.J. Cooper; E. Czeiter; M. Czosnyka; K. Dams-O'Connor; V. De Keyser; R. Diaz-Arrastia; A. Ercole; T.A. van Essen; E. Falvey; A.R. Ferguson; A. Figaji; M. Fitzgerald; B. Foreman; D. Gantner; G.Y. Gao; J. Giacino; B. Gravesteijn; F. Guiza; D. Gupta; M. Gurnell; J.A. Haagsma; F.M. Hammond; G. Hawryluk; P. Hutchinson; M. van der Jagt; S. Jain; J.Y. Jiang; H. Kent; A. Kolias; E.J.O. Kompanje; F. Lecky; H.F. Lingsma; M. Maegele; InTBIR Participants and Investigators

doi:10.1016/S1474-4422(22)00309-X

Traumatic brain injury: progress and challenges in prevention, clinical care, and research

A.I.R. Maas^*, D.K. Menon^*, G.T. Manley, M. Abrams, C. Akerlund, N. Andelic, M. Aries, T. Bashford, M.J. Bell, Y.G. Bodien, B.L. Brett, A. Buki, R.M. Chesnut, G. Citerio, D. Clark, B. Clasby, D.J. Cooper, E. Czeiter, M. Czosnyka, K. Dams-O'ConnorV. De Keyser, R. Diaz-Arrastia, A. Ercole, T.A. van Essen, E. Falvey, A.R. Ferguson, A. Figaji, M. Fitzgerald, B. Foreman, D. Gantner, G.Y. Gao, J. Giacino, B. Gravesteijn, F. Guiza, D. Gupta, M. Gurnell, J.A. Haagsma, F.M. Hammond, G. Hawryluk, P. Hutchinson, M. van der Jagt, S. Jain, J.Y. Jiang, H. Kent, A. Kolias, E.J.O. Kompanje, F. Lecky, H.F. Lingsma, M. Maegele, InTBIR Participants and Investigators

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Original language	English
Pages (from-to)	1004-1060
Number of pages	57
Journal	Lancet Neurology
Volume	21
Issue number	11
DOIs	https://doi.org/10.1016/S1474-4422(22)00309-X
Publication status	Published - 1 Nov 2022

Keywords

CEREBRAL PERFUSION-PRESSURE
NEUROTRAUMA EFFECTIVENESS RESEARCH
POSTTRAUMATIC-STRESS-DISORDER
PREHOSPITAL TRIAGE TOOLS
LIFE-SUSTAINING THERAPY
COMMON DATA ELEMENTS
CT HEAD RULE
OUTCOME PREDICTION
INTENSIVE-CARE
MAJOR TRAUMA

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10.1016/S1474-4422(22)00309-X

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Maas, A. I. R., Menon, D. K., Manley, G. T., Abrams, M., Akerlund, C., Andelic, N., Aries, M., Bashford, T., Bell, M. J., Bodien, Y. G., Brett, B. L., Buki, A., Chesnut, R. M., Citerio, G., Clark, D., Clasby, B., Cooper, D. J., Czeiter, E., Czosnyka, M., ... InTBIR Participants and Investigators (2022). Traumatic brain injury: progress and challenges in prevention, clinical care, and research. Lancet Neurology, 21(11), 1004-1060. https://doi.org/10.1016/S1474-4422(22)00309-X

@article{19ca54a0c4434d17b40c511eb41071d4,

title = "Traumatic brain injury: progress and challenges in prevention, clinical care, and research",

keywords = "CEREBRAL PERFUSION-PRESSURE, NEUROTRAUMA EFFECTIVENESS RESEARCH, POSTTRAUMATIC-STRESS-DISORDER, PREHOSPITAL TRIAGE TOOLS, LIFE-SUSTAINING THERAPY, COMMON DATA ELEMENTS, CT HEAD RULE, OUTCOME PREDICTION, INTENSIVE-CARE, MAJOR TRAUMA",

author = "A.I.R. Maas and D.K. Menon and G.T. Manley and M. Abrams and C. Akerlund and N. Andelic and M. Aries and T. Bashford and M.J. Bell and Y.G. Bodien and B.L. Brett and A. Buki and R.M. Chesnut and G. Citerio and D. Clark and B. Clasby and D.J. Cooper and E. Czeiter and M. Czosnyka and K. Dams-O'Connor and {De Keyser}, V. and R. Diaz-Arrastia and A. Ercole and {van Essen}, T.A. and E. Falvey and A.R. Ferguson and A. Figaji and M. Fitzgerald and B. Foreman and D. Gantner and G.Y. Gao and J. Giacino and B. Gravesteijn and F. Guiza and D. Gupta and M. Gurnell and J.A. Haagsma and F.M. Hammond and G. Hawryluk and P. Hutchinson and {van der Jagt}, M. and S. Jain and J.Y. Jiang and H. Kent and A. Kolias and E.J.O. Kompanje and F. Lecky and H.F. Lingsma and M. Maegele and {InTBIR Participants and Investigators}",

note = "Funding Information: We are enormously grateful to our patients with traumatic brain injury—the Commission's most important stakeholders, who have shared their experiences with us and taught us so much. We are deeply indebted to all researchers and study personnel not included in the author list or in the Group contributor list, who contributed to the data collection for the studies reported in this Commission. We acknowledge the support provided by the funding agencies joined in the InTBIR initiative: the Canadian Institutes of Health Research, the European Commission, the US National Institutes of Health-National Institute of Neurological Disorders and Stroke, One Mind, and the US Department of Defense. The Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) project received additional support from NeuroTrauma Sciences, USA; the Hannelore Kohl Stiftung, Germany; and Integra Life Sciences, USA. Synergistic funding for the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study was obtained through the TBI Endpoints Development award from the US Department of Defense. Additionally, DKM was supported through a Senior Investigator Award and funding for the Cambridge Biomedical Research Centre from the UK National Institute for Health and Care Research. Funding Information: No funding was provided specifically for this Commission paper; however, most authors are involved in the International Initiative for Traumatic Brain Injury Research (InTBIR) as a scientific participant or an investigator. This Commission would not have been possible without the indirect facilitation provided by the InTBIR network. AIRM declares consulting fees from PresSura Neuro, Integra Life Sciences, and NeuroTrauma Sciences. DKM reports research support, and educational and consulting fees from Lantmannen AB, GlaxoSmithKline, Calico, PresSura Neuro, NeuroTrauma Sciences, and Integra Neurosciences. GTM declares grants from the US National Institutes of Health-National Institute of Neurological Disorders and Stroke (grant U01NS086090), the US Department of Defense (grant W81XWH-14-2-0176, grant W81XWH-18-2-0042, and contract W81XWH-15-9-0001). MC reports licensing fees for ICM+ software from Cambridge Enterprise and was an honorary (unpaid) director for Medicam. PS reports licensing fees for ICM+ software from Cambridge Enterprise. MBS has in the past 3 years received consulting income from Acadia Pharmaceuticals, Aptinyx, atai Life Sciences, Boehringer Ingelheim, Bionomics, BioXcel Therapeutics, Clexio, Eisai, EmpowerPharm, Engrail Therapeutics, Janssen, Jazz Pharmaceuticals, and Roche/Genentech. MBS also has stock options in Oxeia Biopharmaceuticals and EpiVario and is paid for editorial work on Depression and Anxiety (Editor-in-Chief), Biological Psychiatry (Deputy Editor), and UpToDate (Co-Editor-in-Chief for Psychiatry). KKWW holds stock options in Gryphon Bio. All other authors declare no competing interests. Funding Information: Since publication of the 2017 Commission, much has changed in the field of TBI. Studies have provided new data on epidemiology and casemix of TBI in the hospital setting, and new insights regarding the effects of systems of care on TBI management and outcome. Clinical care has been informed by the results of a substantial body of research since that Commission, much of which was supported by the International TBI Research (InTBIR) initiative, a coalition of major funding bodies that came together in 2011 to support neurotrauma research. 4,5 Although there have been advances in the characterisation of TBI with the use of advanced neuroimaging, blood biomarkers, and genomics, these advances have not yet been fully translated into clinical care. However, there is increasing evidence that these advances will facilitate identification of patients with TBI who share specific disease mechanisms, treatment response characteristics, or prognosis, thus providing a basis for individualised management. Progress has also occurred in the prediction and characterisation of outcome following TBI, and although these advances are still being developed in research settings, their clinical application will likely occur over the next few years. Challenges remain, particularly in low-income and middle-income countries (LMICs), relating to prevention of TBI, access to care, and provision of clinical guidelines that can be implemented in resource-limited contexts. It is also crucial that we ensure equitable integration of researchers from LMICs in neurotrauma research. Disparities in care provision have also been identified in high-income countries (HICs). In the research context, developments both within the TBI field and insights into novel approaches to trial design from the COVID-19 pandemic have highlighted exciting new approaches and opportunities for generating evidence to support clinical care. Many of these new approaches are dependent on collaborative research and data-sharing, a process that can be constrained by regulatory requirements and facilitated by novel data analysis techniques. ",

year = "2022",

month = nov,

day = "1",

doi = "10.1016/S1474-4422(22)00309-X",

language = "English",

volume = "21",

pages = "1004--1060",

journal = "Lancet Neurology",

issn = "1474-4422",

publisher = "Elsevier Ltd",

number = "11",

}

Maas, AIR, Menon, DK, Manley, GT, Abrams, M, Akerlund, C, Andelic, N, Aries, M, Bashford, T, Bell, MJ, Bodien, YG, Brett, BL, Buki, A, Chesnut, RM, Citerio, G, Clark, D, Clasby, B, Cooper, DJ, Czeiter, E, Czosnyka, M, Dams-O'Connor, K, De Keyser, V, Diaz-Arrastia, R, Ercole, A, van Essen, TA, Falvey, E, Ferguson, AR, Figaji, A, Fitzgerald, M, Foreman, B, Gantner, D, Gao, GY, Giacino, J, Gravesteijn, B, Guiza, F, Gupta, D, Gurnell, M, Haagsma, JA, Hammond, FM, Hawryluk, G, Hutchinson, P, van der Jagt, M, Jain, S, Jiang, JY, Kent, H, Kolias, A, Kompanje, EJO, Lecky, F, Lingsma, HF, Maegele, M & InTBIR Participants and Investigators 2022, 'Traumatic brain injury: progress and challenges in prevention, clinical care, and research', Lancet Neurology, vol. 21, no. 11, pp. 1004-1060. https://doi.org/10.1016/S1474-4422(22)00309-X

TY - JOUR

T1 - Traumatic brain injury: progress and challenges in prevention, clinical care, and research

AU - Maas, A.I.R.

AU - Menon, D.K.

AU - Manley, G.T.

AU - Abrams, M.

AU - Akerlund, C.

AU - Andelic, N.

AU - Aries, M.

AU - Bashford, T.

AU - Bell, M.J.

AU - Bodien, Y.G.

AU - Brett, B.L.

AU - Buki, A.

AU - Chesnut, R.M.

AU - Citerio, G.

AU - Clark, D.

AU - Clasby, B.

AU - Cooper, D.J.

AU - Czeiter, E.

AU - Czosnyka, M.

AU - Dams-O'Connor, K.

AU - De Keyser, V.

AU - Diaz-Arrastia, R.

AU - Ercole, A.

AU - van Essen, T.A.

AU - Falvey, E.

AU - Ferguson, A.R.

AU - Figaji, A.

AU - Fitzgerald, M.

AU - Foreman, B.

AU - Gantner, D.

AU - Gao, G.Y.

AU - Giacino, J.

AU - Gravesteijn, B.

AU - Guiza, F.

AU - Gupta, D.

AU - Gurnell, M.

AU - Haagsma, J.A.

AU - Hammond, F.M.

AU - Hawryluk, G.

AU - Hutchinson, P.

AU - van der Jagt, M.

AU - Jain, S.

AU - Jiang, J.Y.

AU - Kent, H.

AU - Kolias, A.

AU - Kompanje, E.J.O.

AU - Lecky, F.

AU - Lingsma, H.F.

AU - Maegele, M.

AU - InTBIR Participants and Investigators

N1 - Funding Information: We are enormously grateful to our patients with traumatic brain injury—the Commission's most important stakeholders, who have shared their experiences with us and taught us so much. We are deeply indebted to all researchers and study personnel not included in the author list or in the Group contributor list, who contributed to the data collection for the studies reported in this Commission. We acknowledge the support provided by the funding agencies joined in the InTBIR initiative: the Canadian Institutes of Health Research, the European Commission, the US National Institutes of Health-National Institute of Neurological Disorders and Stroke, One Mind, and the US Department of Defense. The Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) project received additional support from NeuroTrauma Sciences, USA; the Hannelore Kohl Stiftung, Germany; and Integra Life Sciences, USA. Synergistic funding for the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study was obtained through the TBI Endpoints Development award from the US Department of Defense. Additionally, DKM was supported through a Senior Investigator Award and funding for the Cambridge Biomedical Research Centre from the UK National Institute for Health and Care Research. Funding Information: No funding was provided specifically for this Commission paper; however, most authors are involved in the International Initiative for Traumatic Brain Injury Research (InTBIR) as a scientific participant or an investigator. This Commission would not have been possible without the indirect facilitation provided by the InTBIR network. AIRM declares consulting fees from PresSura Neuro, Integra Life Sciences, and NeuroTrauma Sciences. DKM reports research support, and educational and consulting fees from Lantmannen AB, GlaxoSmithKline, Calico, PresSura Neuro, NeuroTrauma Sciences, and Integra Neurosciences. GTM declares grants from the US National Institutes of Health-National Institute of Neurological Disorders and Stroke (grant U01NS086090), the US Department of Defense (grant W81XWH-14-2-0176, grant W81XWH-18-2-0042, and contract W81XWH-15-9-0001). MC reports licensing fees for ICM+ software from Cambridge Enterprise and was an honorary (unpaid) director for Medicam. PS reports licensing fees for ICM+ software from Cambridge Enterprise. MBS has in the past 3 years received consulting income from Acadia Pharmaceuticals, Aptinyx, atai Life Sciences, Boehringer Ingelheim, Bionomics, BioXcel Therapeutics, Clexio, Eisai, EmpowerPharm, Engrail Therapeutics, Janssen, Jazz Pharmaceuticals, and Roche/Genentech. MBS also has stock options in Oxeia Biopharmaceuticals and EpiVario and is paid for editorial work on Depression and Anxiety (Editor-in-Chief), Biological Psychiatry (Deputy Editor), and UpToDate (Co-Editor-in-Chief for Psychiatry). KKWW holds stock options in Gryphon Bio. All other authors declare no competing interests. Funding Information: Since publication of the 2017 Commission, much has changed in the field of TBI. Studies have provided new data on epidemiology and casemix of TBI in the hospital setting, and new insights regarding the effects of systems of care on TBI management and outcome. Clinical care has been informed by the results of a substantial body of research since that Commission, much of which was supported by the International TBI Research (InTBIR) initiative, a coalition of major funding bodies that came together in 2011 to support neurotrauma research. 4,5 Although there have been advances in the characterisation of TBI with the use of advanced neuroimaging, blood biomarkers, and genomics, these advances have not yet been fully translated into clinical care. However, there is increasing evidence that these advances will facilitate identification of patients with TBI who share specific disease mechanisms, treatment response characteristics, or prognosis, thus providing a basis for individualised management. Progress has also occurred in the prediction and characterisation of outcome following TBI, and although these advances are still being developed in research settings, their clinical application will likely occur over the next few years. Challenges remain, particularly in low-income and middle-income countries (LMICs), relating to prevention of TBI, access to care, and provision of clinical guidelines that can be implemented in resource-limited contexts. It is also crucial that we ensure equitable integration of researchers from LMICs in neurotrauma research. Disparities in care provision have also been identified in high-income countries (HICs). In the research context, developments both within the TBI field and insights into novel approaches to trial design from the COVID-19 pandemic have highlighted exciting new approaches and opportunities for generating evidence to support clinical care. Many of these new approaches are dependent on collaborative research and data-sharing, a process that can be constrained by regulatory requirements and facilitated by novel data analysis techniques.

PY - 2022/11/1

Y1 - 2022/11/1

KW - CEREBRAL PERFUSION-PRESSURE

KW - NEUROTRAUMA EFFECTIVENESS RESEARCH

KW - POSTTRAUMATIC-STRESS-DISORDER

KW - PREHOSPITAL TRIAGE TOOLS

KW - LIFE-SUSTAINING THERAPY

KW - COMMON DATA ELEMENTS

KW - CT HEAD RULE

KW - OUTCOME PREDICTION

KW - INTENSIVE-CARE

KW - MAJOR TRAUMA

U2 - 10.1016/S1474-4422(22)00309-X

DO - 10.1016/S1474-4422(22)00309-X

M3 - Article

C2 - 36183712

SN - 1474-4422

VL - 21

SP - 1004

EP - 1060

JO - Lancet Neurology

JF - Lancet Neurology

IS - 11

ER -