Classification of traumatic brain injury for targeted therapies.
Classification of traumatic brain injury for targeted therapies.
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DOI：
10.1089/neu.2008.0586
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发表时间：
2008-07
影响因子：
4.2
通讯作者：
Workshop Scientific Team and Advisory Panel Members
中科院分区：
文献类型：
--
作者：
Saatman KE;Duhaime AC;Bullock R;Maas AI;Valadka A;Manley GT;Workshop Scientific Team and Advisory Panel Members
创伤性脑损伤（TBI）的异质性被认为是寻找有效治疗干预措施的最重要障碍之一。2007年10月，国家神经疾病和中风研究所在美国脑损伤协会、国防和退伍军人脑损伤中心以及国家残疾和康复研究所的支持下，召开了一次研讨会，概述了开发可靠的，这是一个有效的TBI分类系统，可用于将脑和神经血管损伤的特定模式与适当的治疗干预联系起来。目前，格拉斯哥昏迷量表（GCS）是纳入大多数TBI临床试验的主要选择标准。虽然GCS在TBI的临床管理和预后中非常有用，但它不能提供有关导致神经功能缺损和干预措施靶向的病理生理机制的具体信息。在具有相似病理解剖特征的脑损伤可能具有共同的病理生理机制的前提下，与会者提出，应该为TBI临床试验开发一个新的多维分类系统。一致认为，临床前模型在建立与特定病理解剖类型的TBI相关的病理生理机制和验证给定的治疗方法改善这些靶向TBI类型的结局方面至关重要。在临床试验中，将使用初始诊断入选标准（包括其损伤严重程度）选择具有靶向病理解剖损伤类型的患者。将确定共存的脑损伤类型，并使用多变量预后模型来细化纳入/排除标准和患者分层。结果评估将利用与目标损伤类型相关的终点。目前可用的诊断，监测和评估工具的优点和缺点进行了讨论。建议提高现有或新兴工具的实用性，以促进临床试验的病理解剖学分类方法的实施。
The heterogeneity of traumatic brain injury (TBI) is considered one of the most significant barriers to finding effective therapeutic interventions. In October, 2007, the National Institute of Neurological Disorders and Stroke, with support from the Brain Injury Association of America, the Defense and Veterans Brain Injury Center, and the National Institute of Disability and Rehabilitation Research, convened a workshop to outline the steps needed to develop a reliable, efficient and valid classification system for TBI that could be used to link specific patterns of brain and neurovascular injury with appropriate therapeutic interventions. Currently, the Glasgow Coma Scale (GCS) is the primary selection criterion for inclusion in most TBI clinical trials. While the GCS is extremely useful in the clinical management and prognosis of TBI, it does not provide specific information about the pathophysiologic mechanisms which are responsible for neurological deficits and targeted by interventions. On the premise that brain injuries with similar pathoanatomic features are likely to share common pathophysiologic mechanisms, participants proposed that a new, multidimensional classification system should be developed for TBI clinical trials. It was agreed that preclinical models were vital in establishing pathophysiologic mechanisms relevant to specific pathoanatomic types of TBI and verifying that a given therapeutic approach improves outcome in these targeted TBI types. In a clinical trial, patients with the targeted pathoanatomic injury type would be selected using an initial diagnostic entry criterion, including their severity of injury. Coexisting brain injury types would be identified and multivariate prognostic modeling used for refinement of inclusion/exclusion criteria and patient stratification. Outcome assessment would utilize endpoints relevant to the targeted injury type. Advantages and disadvantages of currently available diagnostic, monitoring, and assessment tools were discussed. Recommendations were made for enhancing the utility of available or emerging tools in order to facilitate implementation of a pathoanatomic classification approach for clinical trials.
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影响因子：
2.4
作者：
Bouwens, Sharon F. M.;van Heugten, Caroline M.;Verhey, Frans R. J.
通讯作者：
Verhey, Frans R. J.
影响因子：
4.1
作者：
GENNARELLI, TA;SPIELMAN, GM;PITTS, LH
通讯作者：
PITTS, LH
影响因子：
2.7
作者：
Graham, DI;Adams, JH;Jennett, B
通讯作者：
Jennett, B
DOI：
10.1017/s1355617703910046
发表时间：
2003-01-01
影响因子：
2.6
作者：
Alderman, N;Burgess, PW;Henman, C
通讯作者：
Henman, C
DOI：
10.1097/00005373-197403000-00001
发表时间：
1974-01-01
影响因子：
--
作者：
BAKER, SP;ONEILL, B;LONG, WB
通讯作者：
LONG, WB