Improving Indo-US Traumatic Brain Injury Outcomes

描述（由申请人提供）：创伤性脑损伤（TBI）是美国和印度发病率和死亡率的主要原因。为了改善严重创伤性脑损伤后的预后，基于证据的美国2007年出版了《严重脑外伤急性医疗管理指南》。然而，研究表明，医院在严重脑外伤中采用基于证据的指南从传播到采用需要10年以上的时间，低依从性可能是由于缺乏结论性建议、缺乏指南知识和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继发性损伤的高发，如缺氧和低血压，这些已知对严重TBI后患者的预后有不利影响。我们的初步数据显示，在美国和印度，缺乏对严重脑外伤指南的采用以及住院后继发损伤的高患病率是严重脑外伤患者预后良好的首要障碍。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创伤性脑损伤途径，也不知道美国的指南是否可以适应国际环境。我们的项目目标是开发和使用严重脑外伤依从性记分卡，量化2007年脑外伤基金会指南的依从性，检查脑外伤后住院继发性损伤的患病率和时间概况，以测试遵守循证指南与结果之间的关系，并开发跨学科的脑外伤护理途径，促进严重脑外伤后患者的依从性和改善预后。指导假设是依从性预测结果，并且开发跨学科的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结果的长期目标的必要的第一步：1)制定一个依从性记分卡，量化对基于证据的TIB指南的依从性，并检查TBI后继发性损伤的患病率和时间特征；2)使用依从性记分卡来确定遵守基于证据的TBI指南与患者预后之间的关系；3)研究基于证据的TBI指南的依从性障碍，并制定跨学科的TBI护理途径，以提高依从性，减少继发性损伤并改善严重TBI后的预后。

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.