Improving Prognostication for Traumatic Brain Injury

改善创伤性脑损伤的预后

• 批准号: 10643695
• 负责人: Amelia Maiga
• 金额: $ 17.46万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10643695
• 关键词: Accounting; Address; Admission activity; Amelia; Area; Award; Biological Markers; Calibration; Caring; Clinical; Clinical Data; Clinical Trials; Clinical stratification; Communication; Critical Illness; Data; Decision Making; Delirium; Development; Development Plans; Discrimination; Elements; Engineering; Enrollment; Environment; Family; Functional disorder; Funding; Glasgow Outcome Scale; Glial Fibrillary Acidic Protein; Goals; Grant; Hospitalization; Hospitals; Hour; Image; Impaired cognition; Impairment; Injury; Inpatients; Institute of Medicine (U.S.); K-Series Research Career Programs; Knowledge; Laboratories; Leadership; Logistic Regressions; Long-Term Effects; Longterm Follow-up; MRI Scans; Medicine; Mentors; Mentorship; Modeling; Multiple Trauma; Nervous System Physiology; Neurocognitive; Neurologic; Neuronal Plasticity; Organ; Outcome; Patient Care; Patient Selection; Patients; Pattern; Persons; Positioning Attribute; Predictive Factor; Principal Investigator; Provider; Public Health; Recovery; Recovery of Function; Reporting; Research; Research Priority; Scientist; Signal Transduction; Statistical Models; Stratification; Subgroup; Surgeon; Survivors; TBI Patients; TBI treatment; Testing; Time; Training; Translating; Trauma; Traumatic Brain Injury; Traumatic Brain Injury recovery; UCHL1 gene; United States National Academy of Sciences; United States National Institutes of Health; Update; Work; X-Ray Computed Tomography; brain dysfunction; career development; clinical care; clinical decision-making; clinical imaging; clinical translation; cognitive recovery; cohort; expectation; experience; follow-up; functional outcomes; imaging biomarker; improved; individual patient; model development; multidisciplinary; neuroimaging; novel; patient oriented; patient responsibilities; predictive modeling; prognostic; prognostic model; prognostication; radiomics; resilience; risk prediction; severe injury; skills; specific biomarkers; survivorship; symposium

PROJECT SUMMARY/ABSTRACT Despite more than 5 million people living in the U.S. with the long-term effects of traumatic brain injury (TBI), it remains unknown at what point the TBI functional recovery trajectory is fixed. Existing TBI prognostic models are imperfect and static, relying on data from admission and the first 6 hours only. Current models explain only one-third of the variability in outcomes. Despite the multiple CT and MRI scans obtained in TBI clinical care, neuroimaging remains underutilized for TBI prognostics. Image-based biomarkers and radiomics can extract predictive signals from neuroimaging already being obtained. Prognostication matters: better prognostics translate to better patient-centered clinical decision making and better prognostic stratification for clinical trials. Multiple TBI therapies have failed in clinical translation due to basic challenges in patient selection and predicting TBI recovery. At many hospitals across the U.S., trauma surgeons are the primary providers responsible for patients with hospitalized TBI. We can and should do better by developing a mature quantitative approach to prognostication that incorporates time-varying clinical data, advanced statistical modeling, TBI-specific biomarkers, and image-based biomarkers from clinical imaging already being obtained. This career development plan (PI: Amelia W. Maiga, Trauma Surgeon) helps sustain a minimum of 75% protected effort to hone her research expertise and eventual independence in advanced statistical modeling, clinical trials, and neuroimaging analysis for TBI prognostication. The research specific aims are to: AIM 1) build and validate a TBI prognostic model for 12-month functional outcomes with rich time-varying clinical data, radiomics imaging analysis, and biomarkers using two NIH cohorts (R01GM120484 and U01NS086090); and AIM 2) conduct a trajectory analysis of long-term functional and neurocognitive outcomes after TBI. This career development plan for Dr. Maiga integrates a) advanced didactics in clinical trials and neurocognitive follow-up in the critically injured, sophisticated statistical modeling, imaging analysis, and scientific communication and leadership; b) participation in local, regional, and national conferences to advance expertise in the above areas; c) a multidisciplinary mentored research experience; and d) an outstanding environment to propel towards independence. Her mentorship team consists of Drs. Mayur B. Patel (Primary Mentor, trauma, critical illness and TBI); Pratik P. Pandharipande (cognitive impairment); Rameela Raman (prognostic modeling, trajectory analysis); James C. Jackson (long-term outcomes); and Bennett A. Landman (neuroimaging, radiomics), supported by a Research Advisory Council of Drs. E. Wesley Ely (Director of Critical Illness and Brain Dysfunction Center); Robert S. Dittus (Director of Vanderbilt’s Institute of Medicine and Public Health); Geoff T. Manley (PI TRACK-TBI; Transforming Research and Clinical Knowledge in TBI). This research award will position Dr. Maiga to become a leader in TBI prognostics.

项目总结/摘要 尽管美国有超过500万人患有创伤性脑损伤的长期影响， (TBI)，仍然不知道TBI功能恢复轨迹固定在什么点。现有TBI预后 模型是不完善的和静态的，仅依赖于入院和前6个小时的数据。现款车型 只能解释三分之一的结果变异。尽管在TBI中获得了多次CT和MRI扫描， 在临床护理中，神经成像仍然未被充分利用于TBI诊断。基于图像的生物标志物和放射组学 可以从已经获得的神经成像中提取预测信号。预测问题：更好 预后学转化为更好的以患者为中心的临床决策和更好的预后分层， 临床试验由于患者的基本挑战，多种TBI疗法在临床转化中失败 选择和预测TBI恢复。在美国的许多医院，创伤外科医生是 负责TBI住院患者的医疗服务提供者。我们可以而且应该通过发展一种成熟的 定量的方法来解释，包括随时间变化的临床数据，先进的统计 建模、TBI特异性生物标志物和来自临床成像的基于图像的生物标志物已经被获得。 这个职业发展计划（PI：Amelia W。Maiga，创伤外科医生）帮助维持至少75%的 保护努力磨练她的研究专业知识和最终的独立性，在先进的统计建模， 临床试验和用于TBI诊断的神经成像分析。研究的具体目标是：目的1） 利用丰富的随时间变化的临床数据，建立并验证12个月功能结局的TBI预后模型， 放射组学成像分析和使用两个NIH队列（R 01 GM 120484和U 01 NS 086090）的生物标志物;以及AIM 2)对TBI后的长期功能和神经认知结果进行轨迹分析。 Maiga博士的职业发展计划整合了a）临床试验中的先进教学法， 神经认知随访在严重受伤，复杂的统计建模，成像分析， 科学交流和领导; B）参加地方、区域和国家会议， 在上述领域的先进专业知识; c）多学科指导的研究经验;以及d） 良好的环境，推动独立。她的导师团队由Mayur B博士组成。 Patel（初级导师，创伤、危重病和创伤性脑损伤）; Pratik P. Pandharipande（认知障碍）; Rameela拉曼（预测建模，轨迹分析）;杰克逊（长期结果）;以及 班尼特A.兰德曼（神经影像学，放射组学），由研究咨询理事会的支持博士。韦斯利 伊利（危重病和脑功能障碍中心主任）;迪图斯（范德比尔特研究所所长 医学和公共卫生）; Geoff T. Manley（PI TRACK-TBI;转化研究和临床 TBI的知识）。该研究奖将使Maiga博士成为TBI诊断学的领导者。