Traumatic Brain Injury in Latin America: Lifespan Analysis

描述(申请人提供)：本申请的目标是在拉丁美洲脑损伤联盟(LABIC)内建立一个卓越中心网络，该中心将与美国合作伙伴合作，开展关于创伤性脑损伤(TBI)的研究和培训计划。我们的具体目标是：#1：在玻利维亚的3个创伤中心进行随机对照试验，测试由ICP监测仪提供的信息指导的重型脑外伤与标准经验方案对治疗结果的影响。#2：在拉丁美洲7个创伤中心的前瞻性观察性研究中，测试资源可获得性/医疗管理与严重脑外伤患者预后之间的关联。#3：建立一个研究中心网络，让研究人员在设计、实施和资助研究项目方面接受过培训，并具有熟练的技能，以解决拉丁美洲的脑损伤和其他大脑疾病。我们的假设是：#1.重型颅脑损伤患者在创伤后6个月，使用ICP监护仪进行急性护理治疗的患者的死亡率显著低于采用标准方案治疗的患者，而神经心理和功能恢复明显好于采用标准治疗方案的患者。2.将颅内压监测纳入重型颅脑损伤患者的护理，可最大限度地减少继发并发症，减少在ICU的住院时间。#3.在ICP监测随机试验中确定的重型脑外伤患者的治疗和结果之间的关联将在前瞻性观察性研究中推广到人群中。#4.在控制了患者和损伤特征后，资源可获得性和医疗管理的变化将与重型颅脑损伤患者的死亡率和功能恢复显著相关。为了实现该项目的目标，将在资源有限的环境中回答有关全面技术创新的重要研究问题，这些问题的各个方面将推广到其他发展中国家和发达国家。将建立在拉丁美洲开展TBI研究的可持续能力。在LABIC的结构内，将对一批专业人员进行临床研究培训，他们将有能力进行研究，回答与拉丁美洲相关和重要的问题。这些研究将建立一个文献基础，拉丁美洲的研究人员可以在此基础上制定自己的脑损伤治疗指南。

DESCRIPTION (provided by applicant): The objective of this application is to establish a network of Centers of Excellence within the Latin American Brain Injury Consortium (LABIC) that will, in collaboration with U.S. partners, conduct research and training programs about traumatic brain injury (TBI). Our specific aims are: #1: In a randomized controlled trial in 3 trauma centers in Bolivia, test the effect on outcomes of management of severe TBI guided by information from ICP monitors vs. a standard empiric protocol. #2: In a prospective, observational study in 7 trauma centers in Latin America, test the association between resource availability/medical management and outcomes for patients with severe TBI. #3: Establish a network of research centers with investigators trained and skilled in the design, conduct, and funding of research programs to address TBI and other brain disorders in Latin America. We hypothesize that: #1. Patients with severe TBI whose acute care treatment is managed using ICP monitors will have significantly lower mortality and better neuropsychological and functional recovery at 6 months post-trauma than those whose treatment is managed with the standard protocol. #2. The incorporation of ICP monitoring into the care of patients with severe TBI will minimize secondary complications and decrease length of stay in ICU. #3. The association between treatment and outcomes for patients with severe TBI identified in the randomized trial of ICP monitoring will generalize to the population in the prospective, observational, study. #4. Variations in resource availability and medical management will be significantly associated with mortality and functional recovery for patients with severe TBI, after controlling for patient and injury characteristics. In fulfilling the aims of this project, important research questions will be answered about TBI in an environment of limited resources, aspects of which will generalize to other developing countries as well as to the developed world. Sustainable capacity to conduct research about TBI in Latin America will be established. Within the structure of LABIC, a cadre of professionals will be trained in clinical research who will be equipped to carry out studies that answer questions which are relevant and important to Latin America. These studies will establish a literature base from which Latin American investigators can generate their own guidelines for the treatment of TBI.