Traumatic Brain Injury in Latin America: Lifespan Analysis

描述（由申请人提供）：本申请的目的是在拉丁美洲脑损伤联盟（LABIC）内建立一个卓越中心网络，该网络将与美国合作伙伴合作，开展有关创伤性脑损伤（TBI）的研究和培训计划。我们的具体目标是：第一名：在玻利维亚的3个创伤中心进行的一项随机对照试验中，测试根据ICP监测仪信息与标准经验方案指导的重度TBI管理对结局的影响。二：在拉丁美洲7个创伤中心进行的一项前瞻性观察性研究中，测试资源可用性/医疗管理与严重TBI患者结局之间的相关性。第三：建立一个研究中心网络，研究人员在设计，实施和资助研究项目方面训练有素，以解决拉丁美洲的TBI和其他脑部疾病。我们假设：#1。使用ICP监测仪进行急性护理治疗的严重TBI患者在创伤后6个月的死亡率显著低于使用标准方案进行治疗的患者，并且神经心理和功能恢复更好。#2.将ICP监测纳入严重TBI患者的护理中将最大限度地减少继发并发症并缩短ICU住院时间。#3. ICP监测随机试验中确定的重度TBI患者的治疗和结局之间的相关性将推广到前瞻性观察性研究中的人群。#4.在控制患者和损伤特征后，资源可用性和医疗管理的变化将与严重TBI患者的死亡率和功能恢复显著相关。在实现这一项目的目标，重要的研究问题将回答有关TBI在资源有限的环境，其中的方面将推广到其他发展中国家以及发达国家。将建立对拉丁美洲创伤性脑损伤进行研究的可持续能力。在LABIC的结构内，将培训一批专业人员进行临床研究，他们将有能力开展研究，回答与拉丁美洲有关和重要的问题。这些研究将建立一个文献基础，拉丁美洲的研究人员可以从中产生自己的TBI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.