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.

项目概要/摘要 尽管美国有超过 500 万人受到创伤性脑损伤的长期影响 (TBI)，目前尚不清楚 TBI 功能恢复轨迹何时固定。现有 TBI 预后 模型不完善且静态，仅依赖于入场和前 6 小时的数据。当前型号 只能解释结果的三分之一的变异性。尽管在 TBI 中获得了多次 CT 和 MRI 扫描 临床护理中，神经影像学在 TBI 预后方面仍未得到充分利用。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影像中提取预测信号。预测很重要：更好 预后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。在美国许多医院，创伤外科医生是主要的 负责住院 TBI 患者的医疗服务提供者。我们可以而且应该通过发展成熟的 定量预测方法，结合了随时间变化的临床数据、先进的统计数据 模型、TBI 特异性生物标志物以及来自临床成像的基于图像的生物标志物已经获得。 该职业发展计划（PI：Amelia W. Maiga，创伤外科医生）有助于维持至少 75% 努力磨练她的研究专业知识并最终在高级统计建模方面取得独立性， TBI 预测的临床试验和神经影像学分析。研究的具体目标是： AIM 1) 利用丰富的时变临床数据构建并验证 12 个月功能结果的 TBI 预后模型， 使用两个 NIH 队列（R01GM120484 和 U01NS086090）进行放射组学成像分析和生物标志物；和目标 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和 重伤患者的神经认知随访、复杂的统计模型、影像分析和 科学沟通和领导力； b) 参加地方、区域和国家会议 提高上述领域的专业知识； c) 多学科指导的研究经验；和 d) 优越的环境，推动独立。她的导师团队由博士组成。马尤尔 B. Patel（主要导师，创伤、危重疾病和 TBI）； Pratik P. Pandharipande（认知障碍）； Rameela Raman（预后建模、轨迹分析）； James C. Jackson（长期成果）；和 Bennett A. Landman（神经影像学、放射组学），由博士研究咨询委员会支持。 E·韦斯利 Ely（危重疾病和脑功能障碍中心主任）； Robert S. Dittus（范德比尔特研究所所长 医学和公共卫生学院）； Geoff T. Manley（PI TRACK-TBI；转变研究和临床 TBI 知识）。该研究奖项将使 Maiga 博士成为 TBI 预测领域的领导者。