Improving Prognostication for Traumatic Brain Injury

改善创伤性脑损伤的预后

• 批准号: 10643695
• 负责人: Amelia Maiga
• 金额: $ 17.46万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10643695
• 关键词: Accounting; Address; Admission activity; Amelia; Area; Award; Biological Markers; Calibration; Caring; Clinical; Clinical Data; Clinical Trials; Clinical stratification; Communication; Critical Illness; Data; Decision Making; Delirium; Development; Development Plans; Discrimination; Elements; Engineering; Enrollment; Environment; Family; Functional disorder; Funding; Glasgow Outcome Scale; Glial Fibrillary Acidic Protein; Goals; Grant; Hospitalization; Hospitals; Hour; Image; Impaired cognition; Impairment; Injury; Inpatients; Institute of Medicine (U.S.); K-Series Research Career Programs; Knowledge; Laboratories; Leadership; Logistic Regressions; Long-Term Effects; Longterm Follow-up; MRI Scans; Medicine; Mentors; Mentorship; Modeling; Multiple Trauma; Nervous System Physiology; Neurocognitive; Neurologic; Neuronal Plasticity; Organ; Outcome; Patient Care; Patient Selection; Patients; Pattern; Persons; Positioning Attribute; Predictive Factor; Principal Investigator; Provider; Public Health; Recovery; Recovery of Function; Reporting; Research; Research Priority; Scientist; Signal Transduction; Statistical Models; Stratification; Subgroup; Surgeon; Survivors; TBI Patients; TBI treatment; Testing; Time; Training; Translating; Trauma; Traumatic Brain Injury; Traumatic Brain Injury recovery; UCHL1 gene; United States National Academy of Sciences; United States National Institutes of Health; Update; Work; X-Ray Computed Tomography; brain dysfunction; career development; clinical care; clinical decision-making; clinical imaging; clinical translation; cognitive recovery; cohort; expectation; experience; follow-up; functional outcomes; imaging biomarker; improved; individual patient; model development; multidisciplinary; neuroimaging; novel; patient oriented; patient responsibilities; predictive modeling; prognostic; prognostic model; prognostication; radiomics; resilience; risk prediction; severe injury; skills; specific biomarkers; survivorship; symposium

PROJECT SUMMARY/ABSTRACT Despite more than 5 million people living in the U.S. with the long-term effects of traumatic brain injury (TBI), it remains unknown at what point the TBI functional recovery trajectory is fixed. Existing TBI prognostic models are imperfect and static, relying on data from admission and the first 6 hours only. Current models explain only one-third of the variability in outcomes. Despite the multiple CT and MRI scans obtained in TBI clinical care, neuroimaging remains underutilized for TBI prognostics. Image-based biomarkers and radiomics can extract predictive signals from neuroimaging already being obtained. Prognostication matters: better prognostics translate to better patient-centered clinical decision making and better prognostic stratification for clinical trials. Multiple TBI therapies have failed in clinical translation due to basic challenges in patient selection and predicting TBI recovery. At many hospitals across the U.S., trauma surgeons are the primary providers responsible for patients with hospitalized TBI. We can and should do better by developing a mature quantitative approach to prognostication that incorporates time-varying clinical data, advanced statistical modeling, TBI-specific biomarkers, and image-based biomarkers from clinical imaging already being obtained. This career development plan (PI: Amelia W. Maiga, Trauma Surgeon) helps sustain a minimum of 75% protected effort to hone her research expertise and eventual independence in advanced statistical modeling, clinical trials, and neuroimaging analysis for TBI prognostication. The research specific aims are to: AIM 1) build and validate a TBI prognostic model for 12-month functional outcomes with rich time-varying clinical data, radiomics imaging analysis, and biomarkers using two NIH cohorts (R01GM120484 and U01NS086090); and AIM 2) conduct a trajectory analysis of long-term functional and neurocognitive outcomes after TBI. This career development plan for Dr. Maiga integrates a) advanced didactics in clinical trials and neurocognitive follow-up in the critically injured, sophisticated statistical modeling, imaging analysis, and scientific communication and leadership; b) participation in local, regional, and national conferences to advance expertise in the above areas; c) a multidisciplinary mentored research experience; and d) an outstanding environment to propel towards independence. Her mentorship team consists of Drs. Mayur B. Patel (Primary Mentor, trauma, critical illness and TBI); Pratik P. Pandharipande (cognitive impairment); Rameela Raman (prognostic modeling, trajectory analysis); James C. Jackson (long-term outcomes); and Bennett A. Landman (neuroimaging, radiomics), supported by a Research Advisory Council of Drs. E. Wesley Ely (Director of Critical Illness and Brain Dysfunction Center); Robert S. Dittus (Director of Vanderbilt’s Institute of Medicine and Public Health); Geoff T. Manley (PI TRACK-TBI; Transforming Research and Clinical Knowledge in TBI). This research award will position Dr. Maiga to become a leader in TBI prognostics.

项目摘要/摘要 尽管有超过500万人居住在美国的长期影响脑损伤 （TBI），TBI功能恢复轨迹固定在什么时候仍然未知。现有的TBI预后 模型是不完美和静态的，仅依赖于入院和最初6个小时的数据。当前模型 仅解释结果的变异性的三分之一。尽管在TBI中获得了多次CT和MRI扫描 临床护理，神经影像学仍然不足用于TBI探针。基于图像的生物标志物和放射线学 可以从已经获得的神经影像中提取预测信号。预后问题：更好 预后可以转化为以患者为中心的临床决策更好的预后和更好的预后分层 临床试验。由于患者的基本挑战，多种TBI疗法的临床翻译失败 选择并预测TBI恢复。在美国的许多医院，创伤外科医生是主要的 负责住院TBI患者的提供者。我们可以而且应该通过发展成熟来做得更好 定量方法提示包含时变临床数据，高级统计数据 从已经获得的临床成像中的建模，TBI特异性生物标志物和基于图像的生物标志物。 这项职业发展计划（PI：Amelia W. Maiga，创伤外科医生）有助于维持至少75％ 保护她的研究专家和最终在高级统计建模中的独立性的努力， 用于TBI提示的临床试验和神经影像学分析。研究的特定目的是：目标1） 构建和验证TBI预后模型，以使用丰富的时变临床数据的12个月功能结果， 放射成像分析和使用两个NIH队列（R01GM120484和U01NS086090）的生物标志物；和目标 2）对TBI后的长期功能和神经认知结果进行轨迹分析。 Maiga博士的这项职业发展计划将a）临床试验中的高级教学术和 严重受伤，复杂的统计建模，成像分析和 科学沟通和领导； b）参加地方，地区和民族会议 提高上述领域的专业知识； c）多学科的修订研究经验； d） 杰出的环境推动独立。她的训练团队由Drs组成。 Mayur B. 帕特尔（主要导师，创伤，危重疾病和TBI）； Pratik P. Pandharapande（认知障碍）； Rameela Raman（预后建模，轨迹分析）；詹姆斯·杰克逊（James C. Jackson）（长期成果）；和 贝内特·A·兰德曼（Bennett A. E. Wesley Ely（严重疾病和大脑功能障碍中心主任）； Robert S. Dittus（范德比尔特学院的主任 医学和公共卫生）； Geoff T. Manley（Pi Track-Tbi；转型研究和临床 TBI的知识）。该研究奖将使Maiga博士成为TBI探针的领导者。