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8 results on '"Huijben, J.A."'

1. High PEEP/low FiO2 ventilation is associated with lower mortality in COVID–19

Author

Ahuja, S., van Akkeren, J.P., Algera, A.G., Algoe, C.K., van Amstel, R.B., Artigas, A., Aydeniz, E., Bailey, M., van den Berg, A.E., van de Berg, P., Bergmans, D.C.J.J., van den Bersselaar, D.I., Bertens, F.A., Bevers, M., Bindels, A.J.G.H., Breel, J.S., de Bruin, S., Bruna, C.L., de Boer, M., Boer, D.P., den Boer, S., Boers, L.S., Bogerd, M.B., Bos, L.D., Bosman, B., Botta, M., de Bie, A.J.R., Baur, O.L., Buiteman-Kruizinga, L.A., Coene, W., Cremer, O.L., Daenen, K., Delmte, M., Determann, R.M., Dieperink, W., Di Leo, V., van Dijk, J., Dongelmans, D.A., Dormans, T., Endeman, H., Elting, L.M., Esmeijer, A.A., Filippini, D., Flim, J.M., Franke, H.S., Galek-aldridge, M.S., de Abreu, M.G. Gama, Girbes, A.R., Go, D.M., Goossen, R.L., de Graaff, M.J., Hagens, L.A., Hansen, H.J., Haringman, J.J., van der Heide, S.T., van der Heiden, P.L.J., Heijnen, N.F.L., Hiel, S.J.P., Hoeijmakers, L.L., Hol, L., Hollmann, M.W., Hoogendoorn, M.E., Horn, J., van der Horst, I., van der Horst, R., Huijben, J.A., Ie, E.L.K., van Ingen, L.E., Ivanov, D.P., Juffermans, N.P., Kranen, H.T., Kho, E., de Klerk, E.S., Koek, N., Gemert, A.W.M.M. Koopman-van, Koopmans, M., Kucukcelebi, S., Kuiper, M.A., Kuipers, L.J., Koornstra, E., Lokhorst, A., de Lange, D.W., Martin-Loeches, I., van Meenen, D.M.P., Mazzinari, G., Moeniralam, H., van Mourik, N., Myatra, S.N., Nijbroek, S.G., van Oosten, P., Offermans, M., Onrust, M., Oostdijk, E.A.N., Paulus, F., Pennartz, C.J., Peršec, J., Peters, V.J.T., Pillay, J.J., Pisani, L., Pisters, T., Prins, A., Purmer, I.M., Rettig, T.C.D., Rezaee, A.S., Roca, O., Roozeman, J., Rozendaal, J., Rosenberg, N.M., Schavemaker, R., Sciascera, A., Schuijt, M.T.U., Schultz, M.J., Neto, A.S. Serpa, Shrestha, G.S., van Silfhout, B., Sjoding, M., Sleeswijk, M.E., van Smaalen, K.M., Smit, M.R., Spronk, P.E., Šribar, A., Strang, A.C., Stilma, W., Swart, P., Tuinman, P.R., Tsonas, A.M., den Uil, C.A., Valk, C.M.A., Veen-Schra, F.L., Vlaar, A.P.J., Veldhuis, L.I., van der Ven, W.H., van der Ven, F.L.I.M., van Velzen, P., Verboom, M., Verhoef, E.J., Vermeulen, T.D., van Vliet, P., van Vliet, R., Voorham, J.S., van der Voort, P.H.J., van Welie, L., Weller, D., Wentink, A.R., Wesselink, H.J.F.T., van der Wier-Lubbers, H., van Wijk, B., van Willigen, H., van der Woude, M.C.E., Weiner, J.J., Winters, T., Wong, W.Y., Yaali, N., Zandvliet, J.M., van Zanten, A.R.H., van Zijl, T.Z.I., Zonneveld, S.A., Goossen, Robin L., van Vliet, Relin, Bos, Lieuwe D.J., Buiteman-Kruizinga, Laura A., Hollman, Markus W., Myatra, Sheila N., Neto, Ary Serpa, Spronk, Peter E., van der Woude, Meta C.E., van Meenen, David M.P., Paulus, Frederique, and Schultz, Marcus J.

Published
2024
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2. Pharmaceutical Venous Thrombosis Prophylaxis in Critically Ill Traumatic Brain Injury Patients

Author

Huijben, J.A., Pisica, D., Ceyisakar, I., Stocchetti, N., Citerio, G., Maas, A.I.R., Steyerberg, E.W., Menon, D.K., Jagt, M. van der, Lingsma, H.F., ICU Stratum, Huijben, J, Pisica, D, Ceyisakar, I, Stocchetti, N, Citerio, G, Maas, A, Steyerberg, E, Menon, D, van der Jagt, M, Lingsma, H, and CENTER-TBI Investigators and Participants for the ICU Stratum

Subjects
traumatic brain injurie, traumatic brain injuries, venous thrombosi, intensive care units, Original Article, Human medicine, venous thrombosis, intensive care unit
Abstract

The aims of this study are to describe the use of pharmaceutical venous thromboembolism (pVTE) prophylaxis in patients with traumatic brain injury (TBI) in Europe and study the association of pVTE prophylaxis with outcome. We included 2006 patients >= 18 years of age admitted to the intensive care unit from the CENTER-TBI study. VTE events were recorded based on clinical symptoms. Variation between 54 centers in pVTE prophylaxis use was assessed with a multi-variate random-effect model and quantified with the median odds ratio (MOR). The association between pVTE prophylaxis and outcome (Glasgow Outcome Scale-Extended at 6 months) was assessed at center level with an instrumental variable analysis and at patient level with a multi-variate proportional odds regression analysis and a propensity-matched analysis. A time-dependent Cox survival regression analysis was conducted to determine the effect of pVTE prophylaxis on survival during hospital stay. The association between VTE prophylaxis and computed tomography (CT) progression was assessed with a logistic regression analysis. Overall, 56 patients (2%) had a VTE during hospital stay. The majority, 1279 patients (64%), received pVTE prophylaxis, with substantial between-center variation (MOR, 2.7; p < 0.001). A moderate association with improved outcome was found at center level (odds ratio [OR], 1.2 [0.7-2.1]) and patient level (multi-variate adjusted OR, 1.4 [1.1-1.7], and propensity adjusted OR, 1.5 [1.1-2.0]), with similar results in subgroup analyses. Survival was higher with the use of pVTE prophylaxis (p < 0.001). We found no clear effect on CT progression (OR, 0.9; CI [0.6-1.2]). Overall, practice policies for pVTE prophylaxis vary substantially between European centers, whereas pVTE prophylaxis may contribute to improved outcome.Trial registration number is NCT02210221 at ClinicalTrials.gov, registered on August 6, 2014 (first patient enrollment on December 19, 2014).

Published
2022

3. Fluid balance and outcome in critically ill patients with traumatic brain injury (CENTER-TBI and OzENTER-TBI) : a prospective, multicentre, comparative effectiveness study

Author

Wiegers, E.J.A., Lingsma, H.F., Huijben, J.A., Cooper, D.J., Citerio, G., Frisvold, S., Helbok, R., Maas, A.I.R., Menon, D.K., Moore, E.M., Stocchetti, N., Dippel, D.W., Steyerberg, E.W., Jagt, M. van der, CENTER-TBI Collaboration Grp, and OzENTER-TBI Collaboration Grp

Abstract

Background Fluid therapy-the administration of fluids to maintain adequate organ tissue perfusion and oxygenation-is essential in patients admitted to the intensive care unit (ICU) with traumatic brain injury. We aimed to quantify the variability in fluid management policies in patients with traumatic brain injury and to study the effect of this variability on patients' outcomes.Methods We did a prospective, multicentre, comparative effectiveness study of two observational cohorts: CENTER-TBI in Europe and OzENTER-TBI in Australia. Patients from 55 hospitals in 18 countries, aged 16 years or older with traumatic brain injury requiring a head CT, and admitted to the ICU were included in this analysis. We extracted data on demographics, injury, and clinical and treatment characteristics, and calculated the mean daily fluid balance (difference between fluid input and loss) and mean daily fluid input during ICU stay per patient. We analysed the association of fluid balance and input with ICU mortality and functional outcome at 6 months, measured by the Glasgow Outcome Scale Extended (GOSE). Patient-level analyses relied on adjustment for key characteristics per patient, whereas centre-level analyses used the centre as the instrumental variable.Findings 2125 patients enrolled in CENTER-TBI and OzENTER-TBI between Dec 19, 2014, and Dec 17, 2017, were eligible for inclusion in this analysis. The median age was 50 years (IQR 31 to 66) and 1566 (74%) of patients were male. The median of the mean daily fluid input ranged from 1middot48 L (IQR 1middot12 to 2middot09) to 4middot23 L (3middot78 to 4middot94) across centres. The median of the mean daily fluid balance ranged from -0middot85 L (IQR -1middot51 to -0middot49) to 1middot13 L (0middot99 to 1middot37) across centres. In patient-level analyses, a mean positive daily fluid balance was associated with higher ICU mortality (odds ratio [OR] 1middot10 [95% CI 1middot07 to 1middot12] per 0middot1 L increase) and worse functional outcome (1middot04 [1middot02 to 1middot05] per 0middot1 L increase); higher mean daily fluid input was also associated with higher ICU mortality (1middot05 [1middot03 to 1middot06] per 0middot1 L increase) and worse functional outcome (1middot04 [1middot03 to 1middot04] per 1-point decrease of the GOSE per 0middot1 L increase). Centre-level analyses showed similar associations of higher fluid balance with ICU mortality (OR 1middot17 [95% CI 1middot05 to 1middot29]) and worse functional outcome (1middot07 [1middot02 to 1middot13]), but higher fluid input was not associated with ICU mortality (OR 0middot95 [0middot90 to 1middot00]) or worse functional outcome (1middot01 [0middot98 to 1middot03]).Interpretation In critically ill patients with traumatic brain injury, there is significant variability in fluid management, with more positive fluid balances being associated with worse outcomes. These results, when added to previous evidence, suggest that aiming for neutral fluid balances, indicating a state of normovolaemia, contributes to improved outcome. Copyright (C) 2021 Elsevier Ltd. All rights reserved.

Published
2021

4. Development of a quality indicator set to measure and improve quality of ICU care for patients with traumatic brain injury

Author

Huijben, J.A., Wiegers, E.J.A., de Keizer, N.F., Maas, A.I.R., Menon, D., Ercole, A., Citerio, G., Lecky, F., Wilson, L., Cnossen, M.C., Polinder, S., Steyerberg, E.W., van der Jagt, M., Lingsma, H.F., and Delphi panel

Abstract

BACKGROUND: We aimed to develop a set of quality indicators for patients with traumatic brain injury (TBI) in intensive care units (ICUs) across Europe and to explore barriers and facilitators for implementation of these quality indicators. METHODS: A preliminary list of 66 quality indicators was developed, based on current guidelines, existing practice variation, and clinical expertise in TBI management at the ICU. Eight TBI experts of the Advisory Committee preselected the quality indicators during a first Delphi round. A larger Europe-wide expert panel was recruited for the next two Delphi rounds. Quality indicator definitions were evaluated on four criteria: validity (better performance on the indicator reflects better processes of care and leads to better patient outcome), feasibility (data are available or easy to obtain), discriminability (variability in clinical practice), and actionability (professionals can act based on the indicator). Experts scored indicators on a 5-point Likert scale delivered by an electronic survey tool. RESULTS: The expert panel consisted of 50 experts from 18 countries across Europe, mostly intensivists (N = 24, 48%) and neurosurgeons (N = 7, 14%). Experts agreed on a final set of 42 indicators to assess quality of ICU care: 17 structure indicators, 16 process indicators, and 9 outcome indicators. Experts are motivated to implement this finally proposed set (N = 49, 98%) and indicated routine measurement in registries (N = 41, 82%), benchmarking (N = 42, 84%), and quality improvement programs (N = 41, 82%) as future steps. Administrative burden was indicated as the most important barrier for implementation of the indicator set (N = 48, 98%). CONCLUSIONS: This Delphi consensus study gives insight in which quality indicators have the potential to improve quality of TBI care at European ICUs. The proposed quality indicator set is recommended to be used across Europe for registry purposes to gain insight in current ICU practices and outcomes of patients with TBI. This indicator set may become an important tool to support benchmarking and quality improvement programs for patients with TBI in the future.

Published
2019

5. Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury: A survey in 66 neurotrauma centers participating in the CENTER-TBI study

Author

Cnossen, M.C., Huijben, J.A., van der Jagt, M., Volovici, V., van Essen, T., Polinder, S., Nelson, D., Ercole, A., Stocchetti, N., Citerio, G., Peul, W.C., Maas, A.I.R., Menon, D., Steyerberg, E.W., Lingsma, H.F., Adams, H., Alessandro, M., Allanson, J., Amrein, K., Andaluz, N., Andelic, N., Andrea, N., Andreassen, L., Anke, A., Antoni, A., Ardon, H., Audibert, G., Auslands, K., Azouvi, P., Baciu, C., Bacon, A., Badenes, R., Baglin, T., Bartels, R., Barzó, P., Bauerfeind, U., Beer, R., Belda, F.J., Bellander, B.M., Belli, A., Bellier, R., Benali, H., Benard, T., Berardino, M., Beretta, L., Beynon, C., Bilotta, F., Binder, H., Biqiri, E., Blaabjerg, M., Lund, S.B., Bouzat, P., Bragge, P., Brazinova, A., Brehar, F., Brorsson, C., Buki, A., Bullinger, M., Bucková, V., Calappi, E., Cameron, P., Carbayo, L.G., Carise, E., Carpenter, K., Castaño-León, A.M., Causin, F., Chevallard, G., Chieregato, A., Cnossen, M., Coburn, M., Coles, J., Cooper, J.D., Correia, M., Covic, A., Curry, N., Czeiter, E., Czosnyka, M., Dahyot-Fizelier, C., Damas, F., Damas, P., Dawes, H., De Keyser, V., Corte, F.D., Depreitere, B., Ding, S., Dippel, D., Dizdarevic, K., Dulière, G.L., Dzeko, A., Eapen, G., Engemann, H., Esser, P., and on behalf of the CENTER-TBI investigators, .

Subjects
nervous system diseases
Abstract

Background: No definitive evidence exists on how intracranial hypertension should be treated in patients with traumatic brain injury (TBI). It is therefore likely that centers and practitioners individually balance potential benefits and risks of different intracranial pressure (ICP) management strategies, resulting in practice variation. The aim of this study was to examine variation in monitoring and treatment policies for intracranial hypertension in patients with TBI. Methods: A 29-item survey on ICP monitoring and treatment was developed on the basis of literature and expert opinion, and it was pilot-tested in 16 centers. The questionnaire was sent to 68 neurotrauma centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Results: The survey was completed by 66 centers (97% response rate). Centers were mainly academic hospitals (n=60, 91%) and designated level I trauma centers (n=44, 67%). The Brain Trauma Foundation guidelines were used in 49 (74%) centers. Approximately 90% of the participants (n=58) indicated placing an ICP monitor in patients with severe TBI and computed tomographic abnormalities. There was no consensus on other indications or on peri-insertion precautions. We found wide variation in the use of first- and second-tier treatments for elevated ICP. Approximately half of the centers were classified as using a relatively aggressive approach to ICP monitoring and treatment (n=32, 48%), whereas the others were considered more conservative (n=34, 52%). Conclusions: Substantial variation was found regarding monitoring and treatment policies in patients with TBI and intracranial hypertension. The results of this survey indicate a lack of consensus between European neurotrauma centers and provide an opportunity and necessity for comparative effectiveness research.

Published
2017

6. Variation in general supportive and preventive intensive care management of traumatic brain injury: a survey in 66 neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study

Author

Huijben, J.A., Volovici, V., Cnossen, M.C., Haitsma, I.K., Stocchetti, N., Maas, A.I., Menon, D.K., Ercole, A., Citerio, G., Nelson, D., Polinder, S., Steyerberg, Ewout W., Hoedemaekers, A., Lingsma, H.F., Jagt, M. van der, Huijben, J.A., Volovici, V., Cnossen, M.C., Haitsma, I.K., Stocchetti, N., Maas, A.I., Menon, D.K., Ercole, A., Citerio, G., Nelson, D., Polinder, S., Steyerberg, Ewout W., Hoedemaekers, A., Lingsma, H.F., and Jagt, M. van der

Abstract

Contains fulltext : 196341.pdf (publisher's version ) (Open Access), BACKGROUND: General supportive and preventive measures in the intensive care management of traumatic brain injury (TBI) aim to prevent or limit secondary brain injury and optimize recovery. The aim of this survey was to assess and quantify variation in perceptions on intensive care unit (ICU) management of patients with TBI in European neurotrauma centers. METHODS: We performed a survey as part of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. We analyzed 23 questions focused on: 1) circulatory and respiratory management; 2) fever control; 3) use of corticosteroids; 4) nutrition and glucose management; and 5) seizure prophylaxis and treatment. RESULTS: The survey was completed predominantly by intensivists (n = 33, 50%) and neurosurgeons (n = 23, 35%) from 66 centers (97% response rate). The most common cerebral perfusion pressure (CPP) target was > 60 mmHg (n = 39, 60%) and/or an individualized target (n = 25, 38%). To support CPP, crystalloid fluid loading (n = 60, 91%) was generally preferred over albumin (n = 15, 23%), and vasopressors (n = 63, 96%) over inotropes (n = 29, 44%). The most commonly reported target of partial pressure of carbon dioxide in arterial blood (PaCO2) was 36-40 mmHg (4.8-5.3 kPa) in case of controlled intracranial pressure (ICP) < 20 mmHg (n = 45, 69%) and PaCO2 target of 30-35 mmHg (4-4.7 kPa) in case of raised ICP (n = 40, 62%). Almost all respondents indicated to generally treat fever (n = 65, 98%) with paracetamol (n = 61, 92%) and/or external cooling (n = 49, 74%). Conventional glucose management (n = 43, 66%) was preferred over tight glycemic control (n = 18, 28%). More than half of the respondents indicated to aim for full caloric replacement within 7 days (n = 43, 66%) using enteral nutrition (n = 60, 92%). Indications for and duration of seizure prophylaxis varied, and levetiracetam was mostly reported as the agent of choice for both seizure prophylaxis (n = 32, 49%) an

Published
2018

7. Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury: A survey in 66 neurotrauma centers participating in the CENTER-TBI study

Author

Cnossen, M.C. (Maryse), Huijben, J.A. (Jilske A.), van der Jagt, M. (Mathieu), Volovici, V. (Victor), van Essen, T. (Thomas), Polinder, S. (Suzanne), Nelson, D. (David), Ercole, A. (Ari), Stocchetti, N. (Nino), Citerio, G. (Giuseppe), Peul, W.C. (Wilco), Maas, A.I.R. (Andrew), Menon, D.K. (David ), Steyerberg, E.W. (Ewout), Lingsma, H.F. (Hester F.), Adams, H. (Hadie), Alessandro, M. (Masala), Allanson, J.E. (Judith), Amrein, K. (Krisztina), Andaluz, N. (Norberto), Andelic, N. (Nada), Andrea, N. (Nanni), Andreassen, L. (Lasse), Anke, A. (Audny), Antoni, A. (Anna), Ardon, H. (Hilko), Audibert, G. (Gérard), Auslands, K. (Kaspars), Azouvi, P. (Philippe), Baciu, C. (Camelia), Bacon, A. (Andrew), Badenes, R. (Rafael), Baglin, T. (Trevor), Bartels, R.H.M.A. (Ronald), Barzo, P. (P.), Bauerfeind, U. (Ursula), Beer, R. (Ronny), Belda, F.J. (Francisco Javier), Bellander, B.-M. (Bo-Michael), Belli, A. (Antonio), Bellier, R. (Rémy), Benali, H. (Habib), Benard, T. (Thierry), Berardino, M. (Maurizio), Beretta, L. (Luigi), Beynon, C. (Christopher), Bilotta, F. (Federico), Binder, H. (Harald), Biqiri, E. (Erta), Blaabjerg, M. (Morten), Lund, S.B. (Stine Borgen), Bouzat, P. (Pierre), Bragge, P. (Peter), Brazinova, A. (Alexandra), Brehar, F. (Felix), Brorsson, C. (Camilla), Buki, A. (Andras), Bullinger, M. (Monika), Bucková, V. (Veronika), Calappi, E. (Emiliana), Cameron, P. (Peter), Carbayo, L.G. (Lozano Guillermo), Carise, E. (Elsa), Carpenter, K.L.H. (Keri L.H.), Castaño-León, A.M. (Ana M.), Causin, F. (Francesco), Chevallard, G. (Giorgio), Chieregato, A. (Arturo), Cnossen, M. (Maryse), Coburn, M. (Mark), Coles, J.P. (Jonathan P.), Cooper, J.D. (Jamie D.), Correia, M. (Marta), Covic, A. (Amra), Curry, N. (Nicola), Czeiter, E. (Endre), Czosnyka, M. (Marek), Dahyot-Fizelier, C. (Claire), Damas, F. (François), Damas, P. (Pierre), Dawes, H. (Helen), De Keyser, V. (Véronique), Corte, F.D. (Francesco), Depreitere, B. (Bart), Ding, S. (Shenghao), Dippel, D.W.J. (Diederik), Dizdarevic, K. (Kemal), Dulière, G.-L. (Guy-Loup), Dzeko, A. (Adelaida), Eapen, G. (George), Engemann, H. (Heiko), Esser, P. (Patrick), Ezer, E. (Erzsébet), Fabricius, M. (Martin), Feigin, V.L. (V.), Feng, J. (Junfeng), Foks, K. (Kelly), Fossi, F. (Francesca), Francony, G. (Gilles), Frantzén, J. (Janek), Freo, U. (Ulderico), Frisvold, S.K. (Shirin Kordasti), Furmanov, A. (Alex), Gagliardo, P. (Pablo), Galanaud, D. (Damien), Gao, G. (Guoyi), Geleijns, K. (Karin), Ghuysen, A. (Alexandre), Giraud, B. (Benoit), Glocker, B. (Ben), Gomez, P.A. (Pedro A.), Grossi, F. (Francesca), Gruen, R.L. (Russell), Gupta, D. (Deepak), Haagsma, J.A. (Juanita), Hadzic, E. (Ermin), Haitsma, I. (Iain), Hartings, J.A. (Jed), Helbok, R. (Raimund), Helseth, E. (Eirik), Hertle, D. (Daniel), Hill, S. (Sean), Hoedemaekers, A. (Astrid), Hoefer, S. (Stefan), Hutchinson, P.J. (Peter J.), Håberg, K.A. (Kristine Asta), Jacobs, B.C. (Bart), Janciak, I. (Ivan), Janssens, K. (Koen), Jiang, J.-Y. (Ji-Yao), Jones, K. (Kelly), Kalala, J.-P. (Jean-Pierre), Kamnitsas, K. (Konstantinos), Karan, M. (Mladen), Karau, J. (Jana), Katila, A. (Ari), Kaukonen, M. (Maija), Keeling, D. (David), Kerforne, T. (Thomas), Ketharanathan, N. (Naomi), Kettunen, J. (Johannes), Kivisaari, R. (Riku), Kolias, A.G. (Angelos G.), Kolumbán, B. (Bálint), Kompanje, E.J.O. (Erwin), Kondziella, D. (Daniel), Koskinen, L.-O. (Lars-Owe), Kovács, N. (Noémi), Kalovits, F. (Ferenc), Lagares, A. (Alfonso), Lanyon, L. (Linda), Laureys, S. (Steven), Lauritzen, M. (Martin), Lecky, F.E. (Fiona), Ledig, C. (Christian), Lefering, R., Legrand, V. (Valerie), Lei, J. (Jin), Levi, L. (Leon), Lightfoot, R. (Roger), Lingsma, H.F. (Hester), Loeckx, D. (Dirk), Lozano, A. (Angels), Luddington, R. (Roger), Luijten-Arts, C. (Chantal), Maas, A.I.R. (Andrew I.R.), MacDonald, S. (Stephen), MacFayden, C. (Charles), Maegele, M. (Marc), Majdan, M. (Marek), Major, S. (Sebastian), Manara, A. (Alex), Manhes, P. (Pauline), Manley, G. (Geoffrey), Martin, D. (Didier), Martino, C. (Costanza), Maruenda, A. (Armando), Maréchal, H. (Hugues), Mastelova, D. (Dagmara), Mattern, J. (Julia), McMahon, C. (Catherine), Melegh, B. (Béla), Menon, D. (David), Menovsky, T. (Tomas), Morganti-Kossmann, C. (Cristina), Mulazzi, D. (Davide), Mutschler, M. (Manuel), Mühlan, H. (Holger), Negru, A. (Ancuta), Neugebauer, E. (Eddy), Newcombe, V.F. (Virginia F.), Noirhomme, Q. (Quentin), Nyirádi, J. (József), Oddo, M. (Mauro), Oldenbeuving, A.W., Oresic, M. (Matej), Ortolano, F. (Fabrizio), Palotie, A. (Aarno), Parizel, P.M., Patruno, A. (Adriana), Payen, J.-F. (Jean-François), Perera, N. (Natascha), Perlbarg, V. (Vincent), Persona, P. (Paolo), Peul, W. (Wilco), Pichon, N. (Nicolas), Piilgaard, H. (Henning), Piippo, A. (Anna), Floury, S.P. (Sébastien Pili), Pirinen, M. (Matti), Ples, H. (Horia), Pomposo, I. (Inigo), Psota, M. (Marek), Pullens, P. (Pim), Puybasset, L. (Louis), Ragauskas, A. (Arminas), Raj, R. (Rahul), Rambadagalla, M. (Malinka), Rehorcíková, V. (Veronika), Rhodes, J.K.J. (Jonathan K.J.), Richardson, S. (Sylvia), Ripatti, S. (Samuli), Rocka, S. (Saulius), Rodier, N. (Nicolas), Roe, C. (Cecilie), Roise, O. (Olav), Roks, C.M.A.A. (Gerwin), Romegoux, P. (Pauline), Rosand, J. (Jonathan), Rosenfeld, J. (Jeffrey), Rosenlund, C. (Christina), Rosenthal, G. (Guy), Rossaint, R. (Rolf), Rossi, S. (Sandra), Rostalski, T. (Tim), Rueckert, D. (Daniel), de Ruiz, A.F. (Arcaute Felix), Rusnák, M. (Martin), Sacchi, M. (Marco), Sahakian, B. (Barbara), Sahuquillo, J. (Juan), Sakowitz, O. (Oliver), Sala, F. (Francesca), Sanchez-Pena, P. (Paola), Sanchez-Porras, R. (Renan), Sandor, J. (Janos), Santos, E. (Edgar), Sasse, N. (Nadine), Sasu, L. (Luminita), Savo, D. (Davide), Schipper, I.B. (Inger), Schlößer, B. (Barbara), Schmidt, S. (Silke), Schneider, A. (Annette), Schoechl, H. (Herbert), Schoonman, G.G. (Guus), Rico, F.S. (Frederik Schou), Schwendenwein, E. (Elisabeth), Schöll, M. (Michael), Sir, O. (özcan), Skandsen, T. (Toril), Smakman, L. (Lidwien), Smeets, D. (Dominique), Smielewski, P. (Peter), Sorinola, A. (Abayomi), Stamatakis, E. (Emmanuel), Stanworth, S. (Simon), Stegemann, K. (Katrin), Steinbüchel, N. (Nicole), Stevens, R. (Robert), Stewart, W. (William), Sundström, N. (Nina), Synnot, A. (Anneliese), Szabó, J. (József), Söderberg, J. (Jeannette), Taccone, F.S. (Fabio), Tamás, V. (Viktória), Tanskanen, P. (Päivi), Tascu, A. (Alexandru), Taylor, M.S. (Mark Steven), Te, A.B. (Ao Braden), Tenovuo, O. (Olli), Teodorani, G. (Guido), Theadom, A. (Alice), Thomas, M. (Matt), Tibboel, D. (Dick), Tolias, C.M. (Christos M.), Tshibanda, J.-F.L. (Jean-Flory Luaba), Tudora, C.M. (Cristina Maria), Vajkoczy, P. (Peter), Valeinis, E. (Egils), Hecke, W.V. (Wim Van), Praag, D.V. (Dominique Van), Dirk, V.R. (Van Roost), Vlierberghe, E.V. (Eline Van), Vyvere, T.V. (Thijs vande), Vanhaudenhuyse, A. (Audrey), Vargiolu, A. (Alessia), Vega, E. (Emmanuel), Verheyden, J. (Jan), Vespa, P.M. (Paul M.), Vik, A. (Anne), Vilcinis, R. (Rimantas), Vizzino, G. (Giacinta), Vleggeert-Lankamp, C.L.A.M. (Carmen), Vulekovic, P. (Peter), Vámos, Z. (Zoltán), Wade, D. (Derick), Wang, K.K.W. (Kevin K.W.), Wang, L. (Lei), Wildschut, E.D. (Enno), Williams, G. (Guy), Willumsen, L. (Lisette), Wilson, A. (Adam), Wilson, L. (Lindsay), Winkler, M.K.L. (Maren K.L.), Ylén, P. (Peter), Younsi, A. (Alexander), Zaaroor, M. (Menashe), Zhang, Z. (Zhiqun), Zheng, Z. (Zelong), Zumbo, F. (Fabrizio), de Lange, S. (Stefanie), De Ruiter, G.C.W. (Godard C.W.), den Boogert, H. (Hugo), van Dijck, J. (Jeroen), Essen, T.A. (T.) van, van Heugten, C.M. (Caroline M.), Jagt, M. (Mathieu) van der, Naalt, J. (Joukje) van der, Cnossen, M.C. (Maryse), Huijben, J.A. (Jilske A.), van der Jagt, M. (Mathieu), Volovici, V. (Victor), van Essen, T. (Thomas), Polinder, S. (Suzanne), Nelson, D. (David), Ercole, A. (Ari), Stocchetti, N. (Nino), Citerio, G. (Giuseppe), Peul, W.C. (Wilco), Maas, A.I.R. (Andrew), Menon, D.K. (David ), Steyerberg, E.W. (Ewout), Lingsma, H.F. (Hester F.), Adams, H. (Hadie), Alessandro, M. (Masala), Allanson, J.E. (Judith), Amrein, K. (Krisztina), Andaluz, N. (Norberto), Andelic, N. (Nada), Andrea, N. (Nanni), Andreassen, L. (Lasse), Anke, A. (Audny), Antoni, A. (Anna), Ardon, H. (Hilko), Audibert, G. (Gérard), Auslands, K. (Kaspars), Azouvi, P. (Philippe), Baciu, C. (Camelia), Bacon, A. (Andrew), Badenes, R. (Rafael), Baglin, T. (Trevor), Bartels, R.H.M.A. (Ronald), Barzo, P. (P.), Bauerfeind, U. (Ursula), Beer, R. (Ronny), Belda, F.J. (Francisco Javier), Bellander, B.-M. (Bo-Michael), Belli, A. (Antonio), Bellier, R. (Rémy), Benali, H. (Habib), Benard, T. (Thierry), Berardino, M. (Maurizio), Beretta, L. (Luigi), Beynon, C. (Christopher), Bilotta, F. (Federico), Binder, H. (Harald), Biqiri, E. (Erta), Blaabjerg, M. (Morten), Lund, S.B. (Stine Borgen), Bouzat, P. (Pierre), Bragge, P. (Peter), Brazinova, A. (Alexandra), Brehar, F. (Felix), Brorsson, C. (Camilla), Buki, A. (Andras), Bullinger, M. (Monika), Bucková, V. (Veronika), Calappi, E. (Emiliana), Cameron, P. (Peter), Carbayo, L.G. (Lozano Guillermo), Carise, E. (Elsa), Carpenter, K.L.H. (Keri L.H.), Castaño-León, A.M. (Ana M.), Causin, F. (Francesco), Chevallard, G. (Giorgio), Chieregato, A. (Arturo), Cnossen, M. (Maryse), Coburn, M. (Mark), Coles, J.P. (Jonathan P.), Cooper, J.D. (Jamie D.), Correia, M. (Marta), Covic, A. (Amra), Curry, N. (Nicola), Czeiter, E. (Endre), Czosnyka, M. (Marek), Dahyot-Fizelier, C. (Claire), Damas, F. (François), Damas, P. (Pierre), Dawes, H. (Helen), De Keyser, V. (Véronique), Corte, F.D. (Francesco), Depreitere, B. (Bart), Ding, S. (Shenghao), Dippel, D.W.J. (Diederik), Dizdarevic, K. (Kemal), Dulière, G.-L. (Guy-Loup), Dzeko, A. (Adelaida), Eapen, G. (George), Engemann, H. (Heiko), Esser, P. (Patrick), Ezer, E. (Erzsébet), Fabricius, M. (Martin), Feigin, V.L. (V.), Feng, J. (Junfeng), Foks, K. (Kelly), Fossi, F. (Francesca), Francony, G. (Gilles), Frantzén, J. (Janek), Freo, U. (Ulderico), Frisvold, S.K. (Shirin Kordasti), Furmanov, A. (Alex), Gagliardo, P. (Pablo), Galanaud, D. (Damien), Gao, G. (Guoyi), Geleijns, K. (Karin), Ghuysen, A. (Alexandre), Giraud, B. (Benoit), Glocker, B. (Ben), Gomez, P.A. (Pedro A.), Grossi, F. (Francesca), Gruen, R.L. (Russell), Gupta, D. (Deepak), Haagsma, J.A. (Juanita), Hadzic, E. (Ermin), Haitsma, I. (Iain), Hartings, J.A. (Jed), Helbok, R. (Raimund), Helseth, E. (Eirik), Hertle, D. (Daniel), Hill, S. (Sean), Hoedemaekers, A. (Astrid), Hoefer, S. (Stefan), Hutchinson, P.J. (Peter J.), Håberg, K.A. (Kristine Asta), Jacobs, B.C. (Bart), Janciak, I. (Ivan), Janssens, K. (Koen), Jiang, J.-Y. (Ji-Yao), Jones, K. (Kelly), Kalala, J.-P. (Jean-Pierre), Kamnitsas, K. (Konstantinos), Karan, M. (Mladen), Karau, J. (Jana), Katila, A. (Ari), Kaukonen, M. (Maija), Keeling, D. (David), Kerforne, T. (Thomas), Ketharanathan, N. (Naomi), Kettunen, J. (Johannes), Kivisaari, R. (Riku), Kolias, A.G. (Angelos G.), Kolumbán, B. (Bálint), Kompanje, E.J.O. (Erwin), Kondziella, D. (Daniel), Koskinen, L.-O. (Lars-Owe), Kovács, N. (Noémi), Kalovits, F. (Ferenc), Lagares, A. (Alfonso), Lanyon, L. (Linda), Laureys, S. (Steven), Lauritzen, M. (Martin), Lecky, F.E. (Fiona), Ledig, C. (Christian), Lefering, R., Legrand, V. (Valerie), Lei, J. (Jin), Levi, L. (Leon), Lightfoot, R. (Roger), Lingsma, H.F. (Hester), Loeckx, D. (Dirk), Lozano, A. (Angels), Luddington, R. (Roger), Luijten-Arts, C. (Chantal), Maas, A.I.R. (Andrew I.R.), MacDonald, S. (Stephen), MacFayden, C. (Charles), Maegele, M. (Marc), Majdan, M. (Marek), Major, S. (Sebastian), Manara, A. (Alex), Manhes, P. (Pauline), Manley, G. (Geoffrey), Martin, D. (Didier), Martino, C. (Costanza), Maruenda, A. (Armando), Maréchal, H. (Hugues), Mastelova, D. (Dagmara), Mattern, J. (Julia), McMahon, C. (Catherine), Melegh, B. (Béla), Menon, D. (David), Menovsky, T. (Tomas), Morganti-Kossmann, C. (Cristina), Mulazzi, D. (Davide), Mutschler, M. (Manuel), Mühlan, H. (Holger), Negru, A. (Ancuta), Neugebauer, E. (Eddy), Newcombe, V.F. (Virginia F.), Noirhomme, Q. (Quentin), Nyirádi, J. (József), Oddo, M. (Mauro), Oldenbeuving, A.W., Oresic, M. (Matej), Ortolano, F. (Fabrizio), Palotie, A. (Aarno), Parizel, P.M., Patruno, A. (Adriana), Payen, J.-F. (Jean-François), Perera, N. (Natascha), Perlbarg, V. (Vincent), Persona, P. (Paolo), Peul, W. (Wilco), Pichon, N. (Nicolas), Piilgaard, H. (Henning), Piippo, A. (Anna), Floury, S.P. (Sébastien Pili), Pirinen, M. (Matti), Ples, H. (Horia), Pomposo, I. (Inigo), Psota, M. (Marek), Pullens, P. (Pim), Puybasset, L. (Louis), Ragauskas, A. (Arminas), Raj, R. (Rahul), Rambadagalla, M. (Malinka), Rehorcíková, V. (Veronika), Rhodes, J.K.J. (Jonathan K.J.), Richardson, S. (Sylvia), Ripatti, S. (Samuli), Rocka, S. (Saulius), Rodier, N. (Nicolas), Roe, C. (Cecilie), Roise, O. (Olav), Roks, C.M.A.A. (Gerwin), Romegoux, P. (Pauline), Rosand, J. (Jonathan), Rosenfeld, J. (Jeffrey), Rosenlund, C. (Christina), Rosenthal, G. (Guy), Rossaint, R. (Rolf), Rossi, S. (Sandra), Rostalski, T. (Tim), Rueckert, D. (Daniel), de Ruiz, A.F. (Arcaute Felix), Rusnák, M. (Martin), Sacchi, M. (Marco), Sahakian, B. (Barbara), Sahuquillo, J. (Juan), Sakowitz, O. (Oliver), Sala, F. (Francesca), Sanchez-Pena, P. (Paola), Sanchez-Porras, R. (Renan), Sandor, J. (Janos), Santos, E. (Edgar), Sasse, N. (Nadine), Sasu, L. (Luminita), Savo, D. (Davide), Schipper, I.B. (Inger), Schlößer, B. (Barbara), Schmidt, S. (Silke), Schneider, A. (Annette), Schoechl, H. (Herbert), Schoonman, G.G. (Guus), Rico, F.S. (Frederik Schou), Schwendenwein, E. (Elisabeth), Schöll, M. (Michael), Sir, O. (özcan), Skandsen, T. (Toril), Smakman, L. (Lidwien), Smeets, D. (Dominique), Smielewski, P. (Peter), Sorinola, A. (Abayomi), Stamatakis, E. (Emmanuel), Stanworth, S. (Simon), Stegemann, K. (Katrin), Steinbüchel, N. (Nicole), Stevens, R. (Robert), Stewart, W. (William), Sundström, N. (Nina), Synnot, A. (Anneliese), Szabó, J. (József), Söderberg, J. (Jeannette), Taccone, F.S. (Fabio), Tamás, V. (Viktória), Tanskanen, P. (Päivi), Tascu, A. (Alexandru), Taylor, M.S. (Mark Steven), Te, A.B. (Ao Braden), Tenovuo, O. (Olli), Teodorani, G. (Guido), Theadom, A. (Alice), Thomas, M. (Matt), Tibboel, D. (Dick), Tolias, C.M. (Christos M.), Tshibanda, J.-F.L. (Jean-Flory Luaba), Tudora, C.M. (Cristina Maria), Vajkoczy, P. (Peter), Valeinis, E. (Egils), Hecke, W.V. (Wim Van), Praag, D.V. (Dominique Van), Dirk, V.R. (Van Roost), Vlierberghe, E.V. (Eline Van), Vyvere, T.V. (Thijs vande), Vanhaudenhuyse, A. (Audrey), Vargiolu, A. (Alessia), Vega, E. (Emmanuel), Verheyden, J. (Jan), Vespa, P.M. (Paul M.), Vik, A. (Anne), Vilcinis, R. (Rimantas), Vizzino, G. (Giacinta), Vleggeert-Lankamp, C.L.A.M. (Carmen), Vulekovic, P. (Peter), Vámos, Z. (Zoltán), Wade, D. (Derick), Wang, K.K.W. (Kevin K.W.), Wang, L. (Lei), Wildschut, E.D. (Enno), Williams, G. (Guy), Willumsen, L. (Lisette), Wilson, A. (Adam), Wilson, L. (Lindsay), Winkler, M.K.L. (Maren K.L.), Ylén, P. (Peter), Younsi, A. (Alexander), Zaaroor, M. (Menashe), Zhang, Z. (Zhiqun), Zheng, Z. (Zelong), Zumbo, F. (Fabrizio), de Lange, S. (Stefanie), De Ruiter, G.C.W. (Godard C.W.), den Boogert, H. (Hugo), van Dijck, J. (Jeroen), Essen, T.A. (T.) van, van Heugten, C.M. (Caroline M.), Jagt, M. (Mathieu) van der, and Naalt, J. (Joukje) van der

Abstract

Background: No definitive evidence exists on how intracranial hypertension should be treated in patients with traumatic brain injury (TBI). It is therefore likely that centers and practitioners individually balance potential benefits and risks of different intracranial pressure (ICP) management strategies, resulting in practice variation. The aim of this study was to examine variation in monitoring and treatment policies for intracranial hypertension in patients with TBI. Methods: A 29-item survey on ICP monitoring and treatment was developed on the basis of literature and expert opinion, and it was pilot-tested in 16 centers. The questionnaire was sent to 68 neurotrauma centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Results: The survey was completed by 66 centers (97% response rate). Centers were mainly academic hospitals (n=60, 91%) and designated level I trauma centers (n=44, 67%). The Brain Trauma Foundation guidelines were used in 49 (74%) centers. Approximately 90% of the participants (n=58) indicated placing an ICP monitor in patients with severe TBI and computed tomographic abnormalities. There was no consensus on other indications or on peri-insertion precautions. We found wide variation in the use of first- and second-tier treatments for elevated ICP. Approximately half of the centers were classified as using a relatively aggressive approach to ICP monitoring and treatment (n=32, 48%), whereas the others were considered more conservative (n=34, 52%). Conclusions: Substantial variation was found regarding monitoring and treatment policies in patients with TBI and intracranial hypertension. The results of this survey indicate a lack of consensus between European neurotrauma centers and provide an opportunity and necessity for comparative effectiveness research.

Published
2017
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8. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research

Author

Maas, A, Menon, D, Adelson, P, Andelic, N, Bell, M, Belli, A, Bragge, P, Brazinova, A, Büki, A, Chesnut, R, CITERIO, GIUSEPPE, Coburn, M, Cooper, D, Crowder, A, Czeiter, E, Czosnyka, M, Diaz arrastia, R, Dreier, J, Duhaime, A, Ercole, A, Van Essen, T, Feigin, V, Gao, G, Giacino, J, Gonzalez lara, L, Gruen, R, Gupta, D, Hartings, J, Hill, S, Jiang, J, Ketharanathan, N, Kompanje, E, Lanyon, L, Laureys, S, Lecky, F, Levin, H, Lingsma, H, Maegele, M, Majdan, M, Manley, G, Marsteller, J, Mascia, L, Mcfadyen, C, Mondello, S, Newcombe, V, Palotie, A, Parizel, P, Peul, W, Piercy, J, Polinder, S, Puybasset, L, Rasmussen, T, Rossaint, R, Smielewski, P, Söderberg, J, Stanworth, S, Stein, M, Von Steinbüchel, N, Stewart, W, Steyerberg, E, Stocchetti, N, Synnot, A, Te Ao, B, Tenovuo, O, Theadom, A, Tibboel, D, Videtta, W, Wang, K, Williams, W, Wilson, L, Yaffe, K, Adams, H, Agnoletti, V, Allanson, J, Amrein, K, Andaluz, N, Anke, A, Antoni, A, Van As, A, Audibert, G, Azaševac, A, Azouvi, P, Azzolini, 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Zaaroor, M, Zelinkova, V, Zemek, R, Zumbo, F, Pediatric Surgery, Intensive Care, and Public Health

Subjects
medicine.medical_specialty, EVIDENCE-BASED MEDICINE, Treatment outcome, Poison control, Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0], EMERGENCY-DEPARTMENT VISITS, Review, PLACEBO-CONTROLLED TRIAL, Middle income country, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], 03 medical and health sciences, 0302 clinical medicine, Intensive care, Brain Injuries, Traumatic, Journal Article, medicine, traumatic barin injury, Humans, 030212 general & internal medicine, Clinical care, Neurologic disease, Psychiatry, DIAGNOSTIC MANAGEMENT STRATEGIES, business.industry, RANDOMIZED CONTROLLED-TRIAL, ACUTE SUBDURAL-HEMATOMA, SEVERE HEAD-INJURY, ROAD TRAFFIC INJURIES, brain injury, Hospital care, 3. Good health, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Brain Injuries, Health care cost, PATIENT-REPORTED OUTCOMES, Human medicine, Neurology (clinical), business, Humanities, 030217 neurology & neurosurgery, GLASGOW COMA SCALE
Abstract

Executive summary A concerted effort to tackle the global health problem posed by traumatic brain injury (TBI) is long overdue. TBI is a public health challenge of vast, but insufficiently recognised, proportions. Worldwide, more than 50 million people have a TBI each year, and it is estimated that about half the world’s population will have one or more TBIs over their lifetime. TBI is the leading cause of mortality in young adults and a major cause of death and disability across all ages in all countries, with a disproportionate burden of disability and death occurring in low-income and middle-income countries (LMICs). It has been estimated that TBI costs the global economy approximately $US400 billion annually. Deficiencies in prevention, care, and research urgently need to be addressed to reduce the huge burden and societal costs of TBI. This Commission highlights priorities and provides expert recommendations for all stakeholders— policy makers, funders, health-care professionals, researchers, and patient representatives—on clinical and research strategies to reduce this growing public health problem and improve the lives of people with TBI. The epidemiology of TBI is changing: in high-income countries, the number of elderly people with TBI is increasing, mainly due to falls, while in LMICs, the burden of TBI from road traffic incidents is increasing. Data on the frequency of TBI and TBI-related deaths and on the economic impact of brain trauma are often incomplete and vary between countries. Improved, accurate epidemiological monitoring and robust healtheconomic data collection are needed to inform healthcare policy and prevention programmes. Highly developed and coordinated systems of care are crucial for management of patients with TBI. However, in practice, implementation of such frameworks varies greatly and disconnects exist in the chain of care. Optimisation of systems of care should be high on the policy agenda and could yield substantial gains in terms of both patient outcomes and costs to society. TBI is a complex condition, and strong evidence to support treatment guidelines and recommendations is scarce. Most multicentre clinical trials of medical and surgical interventions have failed to show efficacy, despite promising preclinical results. At the bedside, treatment strategies are generally based on guidelines that promote a one-size-fits-all approach and are insufficiently targeted to the needs of individual patients. Attempts to individualise treatment are challenging owing to the diversity of TBI, and are hampered by the use of simplistic methods to characterise its initial type and severity. Advances in genomics, blood biomarkers, magnetic resonance imaging (MRI), and pathophysiological monitoring, combined with informatics to integrate data from multiple sources, offer new research avenues to improve disease characterisation and monitoring of disease evolution. These tools can also aid understanding of disease mechanisms and facilitate targeted treatment strategies for individual patients. Individualised management in the postacute phase and evaluation of the effectiveness of treatment and care processes depend on accurate quantification of outcomes. In practice, however, the use of simplistic methods hinders efforts to quantify outcomes after TBI of all severities. Development and validation of multidimensional approaches will be essential to improve measurement of clinical outcomes, for both research and patient care. In particular, we need to find better ways to characterise the currently under-recognised risk of long-term disabling sequelae in patients with relatively mild injuries. Prognostic models are important to help clinicians to provide reliable information to patients and relatives, and to facilitate comparative audit of care between centres and countries. There is an urgent need for further development, validation, and implementation of prognostic models in TBI, particularly for less severe TBI. This multitude of challenges in TBI—encompassing systems of care, clinical management, and research strategy—demands novel approaches to the generation of new evidence and its implementation in clinical practice. Comparative effectiveness research (CER) offers opportunities to capitalise on the diversity of TBI and systems of care and enables assessment of therapies in real-world conditions; high-quality CER studies can provide strong evidence to support guideline recommendations. The global challenges posed by TBI necessitate global collaborations and a change in research culture to endorse broad data sharing. This Commission covers a range of topics that need to be addressed to confront the global burden of TBI and reduce its effects on individuals and society: epidemiology (section 1); health economics (section 2); prevention (section 3); systems of care (section 4); clinical management (section 5); characterisation of TBI (section 6); outcome assessment (section 7); prognosis (section 8); and new directions for acquiring and implementing evidence (section 9). Table 1 summarises key messages from the Commission and provides recommendations to advance clinical care and research in TBI. We must increase awareness of the scale of the challenge posed by TBI. If we are to tackle the individual and societal burden of TBI, these efforts need to go beyond a clinical and research audience and address the public, politicians, and other stakeholders. We need to develop and implement policies for better prevention and systems of care in order to improve outcomes for individuals with TBI. We also need a commitment to substantial long-term investment in TBI research across a range of disciplines to determine best practice and facilitate individualised management strategies. A combination of innovative research methods and global collaboration, and ways to effectively translate progress in basic and clinical research into clinical practice and public health policy, will be vital for progress in the field.

Published
2017
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