Classification of Traumatic Brain Injury for Targeted Therapies
By K. Saatman, A. Duhaime, R. Bullock, Andrew I. R. Maas, A. Valadka, G. Manley. Journal of Neurotrauma, 2008
1,000 citations recorded by the source corpus.
The heterogeneity of traumatic brain injury (TBI) is considered one of the most significant barriers to finding effective therapeutic interventions. In October, 2007, the National Institute of Neurological Disorders and Stroke, with support from the Brain Injury Association of America, the Defense and Veterans Brain Injury Center, and the National Institute of Disability and Rehabilitation Research, convened a workshop to outline the steps needed to develop a reliable, efficient and valid classification system for TBI that could be used to link specific patterns of brain and neurovascular injury with appropriate therapeutic interventions. Currently, the Glasgow Coma Scale (GCS) is the primary selection criterion for inclusion in most TBI clinical trials. While the GCS is extremely useful in the clinical management and prognosis of TBI, it does not provide specific information about the pathophysiologic mechanisms which are responsible for neurological deficits and targeted by interventions. On the premise that brain injuries with similar pathoanatomic features are likely to share common pathophysiologic mechanisms, participants proposed that a new, multidimensional classification system should be developed for TBI clinical trials. It was agreed that preclinical models were vital in establishing pathophysiologic mechanisms relevant to specific pathoanatomic types of TBI and verifying that a given therapeutic approach improves outcome in these targeted TBI types. In a clinical trial, patients with the targeted pathoanatomic injury type would be selected using an initial diagnostic entry criterion, including their severity of injury. Coexisting brain injury types would be identified and multivariate prognostic modeling used for refinement of inclusion/exclusion criteria and patient stratification. Outcome assessment would utilize endpoints relevant to the targeted injury type. Advantages and disadvantages of currently available diagnostic, monitoring, and assessment tools were discussed. Recommendations were made for enhancing the utility of available or emerging tools in order to facilitate implementation of a pathoanatomic classification approach for clinical trials.
Subfields: Emergency Medicine, Epidemiology, Neurology
View Paper: https://www.semanticscholar.org/paper/82660be0d62701c31e39491a0453c71b1e0b6224
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Citations in the corpus
- Neuroinflammation after traumatic brain injury: opportunities for therapeutic intervention. (2012, positive): “…have been made (Loane and Faden, 2010), and they build on the STAIR criteria for development of neuroprotective treatments for stroke/ischemia (Fisher et al., 2009; STAIR, 1999), and are in line with NIH guidelines for effective therapies for TBI (Margulies and Hicks, 2009; Saatman et al., 2008).”
- Blood-brain barrier pathophysiology in traumatic brain injury (2011, background): “Common pathoanatomical consequences of traumatic brain injury (TBI) include hematoma, subarachnoid hemorrhage (SAH), contusion, and diffuse axonal injury [1].”
- Clinical Relevance of Cortical Spreading Depression in Neurological Disorders: Migraine, Malignant Stroke, Subarachnoid and Intracranial Hemorrhage, and Traumatic Brain Injury (2011, background): “Primary injury may consist of any combination of parenchymal contusion, ICH, SAH, extraparenchymal hematoma, and diffuse axonal injury (Saatman et al, 2008), and is often critically compounded by secondary insults including hypotension, hypoxia, fever, and brain edema leading to elevated…”