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Current working groups

a. Observational and comparative effectiveness studies – Fitzgerald and Okonkwo

Observational registries and studies have underscored several important research efforts and advances in recent years in traumatic brain injury and will continue to be key research strategies. The Observational and Comparative Effectiveness Studies working group will act as a focal point and source of expertise for global researchers developing and utilising large scale data assets for traumatic brain injury research. The working group seeks to encourage new research initiatives to incorporate common data elements so as to maximise opportunities, value and impact of internationally collaborative research. The resultant large scale data assets can be used for comparative effectiveness research and to generate predictive models to improve clinical care and outcomes for people with traumatic brain injury.

b. Study design and analysis – Lingsma and Turgeon
c. Clinical trials – Turgeon and Hutchinson

The overall objective of the working group is to assist in the development, design and delivery of clinical trials, specifically multicentre international randomised control trials, in the field of traumatic brain injury.

The aims of the working group are to:

  1. To help developing large scale practice changes international multicentre trials
    1. identify the challenges and solutions in the delivering these trials in relation to:
      1. Defining the research question and equipoise
      2. Protocol design
      3. Conduction and recruitment
  2. Look at novel approaches in terms of trial design and methodology e.g. platform trials, adaptive trial design to increase the efficiency and cost effectiveness of clinical trials
d. Biomarkers & genetics – Diaz-Arrastia and Wellington 

The InTBIR Biomarkers and Genetics Working Group has met roughly monthly for the past 10 years. From the beginning of our collaboration, we aligned our biobanking procedures and times of sample collection in our prospective multi-centre observational studies in the U.S., Europe and Canada. Standardization of protocols and procedures allow adequately powered replication of promising results based on initial pilot data. These biobanks and databases, including TRACK-TBI, CENTER-TBI, and CanTBI, cover the spectrum in age from children to adults and across the spectrum of severity of TBI, from concussion to coma, together with matched controls samples. An important goal of the Working Group is to understand the role of genetic variation in outcomes after TBI, as well as the relationship of genetic variation with quantitative endophenotypes relevant to injury mechanisms, building on the Genetic Association in Neurotrauma (GAIN) initiative. The Biomarkers WG is also committed to collaborations with industry partners in the pre-competitive space, to facilitate the analytical and clinical validation of TBI-relevant biomarkers, for their eventual incorporation into clinical research and ultimately clinical practice.

e. Global health – Hutchinson, Gao, and Gardner

Traumatic brain injury (TBI) is a significant global health problem. Globally TBI is the leading cause of death and disability among adults aged 18-44. The effect is felt most in low-and middle-income countries (LMICs), where 90% of all-trauma-related deaths occur. Since severe TBI disproportionately affects working-age adults, the epidemiologic profile costs LMICs, on average, 1-2% of their GDP annually. 

The NIHR Global Health Research Group on Neurotrauma was founded in 2017 to study four themes:

  1. Mapping TBI care: projects including Global Neurotrauma Outcome Study (GNOS), GNOS Spine, GEOTBI Registry
  2. Understanding TBI care: projects including ASIA-TBI, network modeling of patient flow,  Yangon Early Warning System (YEWS)
  3. Innovation categorized across four sub-themes (A: system refinement for cost-effective outcomes, B: patient triage and risk stratification, C: surgical interventions, D: collection of outcomes)
  4. Research capacity building: projects including BMJ Research to Publication, Global Neurotrauma Fellowships, Neurosurgical Publication Database 

High-income countries are in a world of “precision-based medicine,” where diagnosis and treatment increasingly rely on an individual’s unique genetics and biomarkers. We need to take a similar approach when working within global health. Each country has its own socio-economic and socio-cultural signature that we must evaluate and prepare for when forming new collaborations and implementing new projects. This helps us work within a framework to develop optimal efficacy and sustainability, leading to the delivery of projects to improve the management of TBI worldwide.

f. TBI in Special Populations – Gardner, Wellington, and Zemek 

The majority of TBI research conducted globally to date has focused primarily on young to middle-aged majority male civilians, competitive athletes with mild TBIs (a.k.a. concussion), and military populations. There has been much less research focused specifically on children, especially those less than 5 years of age, older adults, and other unique or under-represented populations who experience TBI including, but not limited to: women, youth with pre-existing mental health conditions, victims of intimate partner violence, incarcerated individuals, and vulnerably housed individuals. This working group will focus on advancing research and informing optimal clinical care worldwide in under-represented TBI populations via identifying and promoting relevant funding mechanisms, facilitating collaborations, and adapting and validating common data elements as needed. An important new initiative is to undertake this research from a culturally informed perspective with attention to the ethical, legal and social implications of TBI in these special populations.

g. Neuroimaging – Nasrallah, Menon and Zanier

Neuroimaging modalities have been at the forefront of unraveling the anatomical, structural, and functional intricacies of the complex brain. Developments in imaging methods, such as Computed tomography (CT), Magnetic Resonance Imaging (MRI), and Positron Emission Tomography (PET) imaging have enabled greater clinical differentiation of different disease trajectories and their underlying brain pathologies. Their application to the study of traumatic brain injury (TBI) provides an unparalleled opportunity to identify different patterns of brain injury that have differing prognoses and therapy requirements and enable a more detailed investigation of the changes that happen in the brain following TBI.  

The neuroimaging working group will work with recognized experts in the fields of neuroimaging to define a framework for how these different imaging modalities can be leveraged to provide complementary information to help understand the effects of trauma on the brain and exploit the inherent variability of TBI. In this concerted effort, the neuroimaging working group will:

  1. Leverage cutting-edge technical and methodological innovations in the field to encompass a full range of imaging modalities.
  2. Establish best practices for data acquisition globally that will maximize data sharing and support multidisciplinary initiatives for neuroimaging of TBI
  3. Seek to build on existing work done in the first generation of InTBIR studies, and also in other large international collaborations.
  4. Provide a platform where data analysis and processing pipelines are made readily available, or sharable through collaboration
  5. To foster harmonization of combined and federated analysis methods across all neuroimaging studies in traumatic brain injury.
  6. Foster international collaborations to develop innovative initiatives of neuroimaging research for traumatic brain injury.
h. Outcomes – Nelson, Manley, and Wilson 

Robust assessment of clinical outcomes in TBI studies requires attention to both pragmatic and complex scientific considerations. The Outcomes working group will serve as a resource for global investigators seeking input on the selection, administration, oversight, management, and analysis of clinical outcome data. The Outcomes working group will facilitate and conduct collaborative research targeting the most pressing needs related to the conceptualization and measurement of clinical outcomes, with a broad objective to advance knowledge and tools for outcome assessment around the globe.

i. Fundamental and Translational – Smith, Zanier and Wellington

The newly established InTBIR Fundamental and Translational Working Group recognizes the importance of cellular and animal model systems to undertake studies difficult or impossible to conduct solely through clinical research. The ability to reliably generate cells or brain tissues injured under controlled experimental conditions allows mechanisms and potential therapeutic targets to be identified. This Working Group aims to strengthen connections among clinical, fundamental and translational scientists to improve the relevance of model systems and increase our understanding of TBI pathophysiology.

j. Data science and harmonisation – Lingsma, Nelson and Abrams

The Data Science and Harmonisation working group will act as a focal point of source of expertise for global researchers working towards data harmonization and infrastructure interoperability for traumatic brain injury research. The working group seeks to encourage existing traumatic brain injury projects to work towards the harmonisation of common data elements and the development of application programming interfaces to ease the burden of data sharing by the international community.

k. Linkage with post-mortem studies - Smith, Stewart

With ever sophisticated pre-clinical models interrogating multiple pathologies in TBI and with continued advances in clinical management, now more than ever there is a need for robust correlation, translation and discovery studies accessing human research tissue resources. The Post-mortem Studies workgroup will leverage experience in existing international multi-center collaborations, such as CONNECT-TBI (add website url to acronym), and wider global archives to facilitate and promote field leading research in TBI utilising human tissue samples.

l. Website – Abrams and Diaz-Arrastia