Improving Indo-US Traumatic Brain Injury Outcomes

描述(申请人提供)：创伤性脑损伤(TBI)是美国发病率和死亡率的主要原因(美国)还有印度。为了改善严重脑外伤后的预后，美国《重型颅脑损伤急诊救治指南》于2007年发布。然而，研究表明，在重型颅脑损伤患者中，医院采用循证指南从传播到采用需要10年以上的时间，遵从性低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会导致严重颅脑损伤后继发性损害的高发，如缺氧和低血压，这些都会对患者的预后产生不利影响。我们的初步数据显示，在美国和印度，没有采用重型脑外伤的指南，以及入院后二次侮辱的发生率很高，这是严重脑外伤后患者预后良好的高度优先障碍。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脑外伤路径，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重型颅脑损伤依从性记分卡，以量化对2007年脑创伤基金会指南的遵守情况，检查医院内颅脑损伤后二次伤害的发生率和时间分布，测试遵守循证指南和预后之间的关联，并开发一种跨学科的颅脑损伤护理路径，以促进重型颅脑损伤后的依从性和改善患者的预后。指导性假设是，坚持预示着结果，发展一条跨学科的创伤性脑损伤护理路径将增加对脑外伤后的依从性并改善结果。针对PAR-11-099，我们联合提出了3个具体目标，作为实现改善两国脑损伤预后的长期目标的必要的第一组步骤：1)开发遵守记分卡，以量化对循证TIB指南的遵守情况，并检查脑损伤后二次伤害的发生率和时间分布；2)使用遵守记分卡，确定遵守循证脑损伤指南与患者预后之间的关系；3)检查遵守循证脑损伤指南的障碍，并开发一种跨学科的脑损伤护理路径，以提高依从性、减少二次侮辱，改善严重脑损伤后的预后。

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.