Toward an international initiative for traumatic brain injury research

Abstract

The European Commission (EC) and the National Institutes of Health (NIH) jointly sponsored a workshop on October 18-20, 2011 in Brussels to discuss the feasibility and benefits of an international collaboration in the field of traumatic brain injury (TBI) research. The workshop brought together scientists, clinicians, patients, and industry representatives from around the globe as well as funding agencies from the EU, Spain, the United States, and Canada. Sessions tackled both the possible goals and governance of a future initiative and the scientific questions that would most benefit from an integrated international effort: how to optimize data collection and sharing; injury classification; outcome measures; clinical study design; and statistical analysis. There was a clear consensus that increased dialogue and coordination of research at an international level would be beneficial for advancing TBI research, treatment, and care. To this end, the EC, the NIH, and the Canadian Institutes of Health Research expressed interest in developing a framework for an international initiative for TBI Research (InTBIR). The workshop participants recommended that InTBIR initially focus on collecting, standardizing, and sharing clinical TBI data for comparative effectiveness research, which will ultimately result in better management and treatments for TBI.

FIG. 1.

Main components of a federated traumatic brain injury database system.

FIG. 2.

Generic structure of a Common Data Elements system.

FIG. 3.

Confounds from the perspective of acute and postacute care researchers. Patient characteristics and rehabilitation interventions produce confounds to the assessment of the effectiveness of acute care interventions on long-term outcome. Initial injury characteristics (1) result in acute treatments that moderate the effect of injury and begin to influence global outcome (2), which is the product of multiple specific functional domains (here illustrated with gait function, memory ability, and employment potential; 3). Soon, one or more rehabilitation interventions are introduced, which alter one or more of these functions (4), in turn affecting long-term outcome (5).

FIG. 4.

Treatment system transitions and injury severity.