- a. Observational and comparative effectiveness studies – Fitzgerald and Okonkwo
- b. Study design and analysis – Lingsma and Turgeon
- c. Clinical trials – Turgeon and Hutchinson
- d. Biomarkers & genetics – Diaz-Arrastia and Wellington
- e. Global health – Hutchinson, Gao, and Gardner
- Mapping TBI care: projects including Global Neurotrauma Outcome Study (GNOS), GNOS Spine, GEOTBI Registry
- Understanding TBI care: projects including ASIA-TBI, network modeling of patient flow, Yangon Early Warning System (YEWS)
- 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)
- Research capacity building: projects including BMJ Research to Publication, Global Neurotrauma Fellowships, Neurosurgical Publication Database
- f. TBI in Special Populations – Gardner, Wellington, and Zemek
- g. Imaging – Nasrallah, Menon and Zanier
- h. Outcomes – Nelson, Manley, and Wilson
- i. Linkage with pre-clinical research – Smith, Zanier and Wellington
- j. Data science and harmonisation – Lingsma, Nelson and Abrams
- k. Website – Abrams and Diaz-Arrastia
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.
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:
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.
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.
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.
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.