Improving Indo-US Traumatic Brain Injury Outcomes

描述（由申请人提供）：创伤性脑损伤（TBI）是美国（U.S.）发病率和死亡率的主要原因。和印度为了改善严重TBI后的结果，2007年发表了基于证据的美国“严重TBI急性医疗管理指南”。然而，研究表明，医院在严重TBI中采用循证指南从传播到采用需要10年以上的时间，并且低依从性可能是由于缺乏结论性建议，缺乏指南知识以及缺乏实施指南的程序等障碍。这是有问题的，因为缺乏对这些指南的遵守可能导致二次损伤的高患病率，例如缺氧和低血压，已知其在严重TBI后对患者结果产生不利影响。我们的初步数据显示，在美国和印度，缺乏采用严重TBI的指南以及入院后二次损伤的高患病率是严重TBI后患者良好结局的高优先级障碍。目前，印度新德里的JPN Apex创伤中心和华盛顿州西雅图的Harborview都没有跨学科的严重TBI路径，也不知道美国的指南是否适用于国际环境。我们的项目目标是开发和使用一个严重的TBI依从性记分卡，量化遵守2007年脑创伤基金会指南，检查院内TBI后二次损伤的患病率和时间概况，以测试遵守循证指南和结果之间的关联，并开发一个跨学科的TBI护理途径，促进遵守和改善严重TBI后患者的结果。指导性假设是依从性预测结果，并且开发跨学科TBI护理途径将增加依从性并改善TBI后的结果。作为对PAR-11-099的回应，我们共同提出了3个具体目标，作为改善两国TBI结局的长期目标的必要的第一组步骤：1）开发一个依从性记分卡，量化对基于证据的TIB指南的依从性，并检查TBI后二次损伤的患病率和时间概况; 2）使用依从性记分卡来确定对基于证据的TBI指南的依从性与患者结果之间的关系; 3）检查遵守循证TBI指南的障碍，并制定跨学科TBI护理途径，以提高依从性，减少二次损伤并改善严重TBI后的结果。

DESCRIPTION (provided by applicant): Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in the United States (U.S.) and India. To improve outcomes after severe TBI, evidence based U.S. "Guidelines for the Acute Medical Management of Severe TBI" were published in 2007. However, studies suggest that hospital adoption of evidence based guidelines in severe TBI takes more than 10 years from dissemination to adoption and that low adherence may be due to barriers such as lack of conclusive recommendations, lack of guideline knowledge, and lack of procedures to implement guidelines. This is problematic because lack of adherence to these guidelines likely results in a high prevalence of secondary insults such as hypoxia and hypotension that are known to adversely affect patient outcomes after severe TBI. Our preliminary data show that the lack of adoption of guidelines for severe TBI and the high prevalence of secondary insults after hospital admission in the U.S. and India are high priority barriers to favorable patient outcomes after severe TBI. Currently, neither JPN Apex Trauma Center in New Delhi, India nor Harborview in Seattle, WA have an interdisciplinary severe TBI pathway, nor is it known if U.S. guidelines can be adapted to international settings. Our project goal is to develop and use a severe TBI adherence scorecard that quantifies adherence to the 2007 Brain Trauma Foundation Guidelines, to examine the prevalence and temporal profile of in-hospital post TBI secondary insults to test the association between adherence to evidence based guidelines and outcomes and to develop an interdisciplinary TBI care pathway that facilitates adherence and improves patient outcomes after severe TBI. The guiding hypothesis is that adherence predicts outcomes and that developing an interdisciplinary TBI care pathway will increase adherence and improve outcomes after TBI. In response to PAR-11-099, we jointly propose 3 Specific Aims as a necessary first set of steps to the long term goal of improving TBI outcomes in both nations: 1) To develop an adherence scorecard that quantifies adherence to evidence based TIB guidelines and examines the prevalence and temporal profile of secondary insults after TBI; 2) To use the adherence scorecard to determine the relationship between adherence to evidence based TBI guidelines and patient outcomes; 3) To examine barriers to adherence of evidence based TBI guidelines and develop an interdisciplinary TBI care pathway that improves adherence, decreases secondary insults and improves outcomes after severe TBI.