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协会（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3个创伤中心的随机对照试验中，测试由ICP监测仪和标准经验方案提供的信息对严重TBI管理结果的影响。#2：在拉丁美洲7个创伤中心进行的一项前瞻性观察研究中，测试了资源可用性/医疗管理与严重TBI患者预后之间的关系。第三：建立一个研究中心网络，由在设计、实施和资助研究项目方面训练有素的研究人员组成，以解决拉丁美洲的创伤性脑损伤和其他脑部疾病。我们假设：#1。与采用标准方案治疗的患者相比，使用ICP监护仪进行急性护理治疗的严重TBI患者在创伤后6个月的死亡率显著降低，神经心理和功能恢复更好。# 2。将颅内压监测纳入严重脑外伤患者的护理中，可减少继发性并发症，缩短ICU住院时间。# 3。在ICP监测随机试验中发现的严重TBI患者的治疗和预后之间的关系将在前瞻性观察性研究中推广到人群。# 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脑外伤患者的死亡率和功能恢复显著相关。为了实现这个项目的目标，将在资源有限的环境下回答关于脑外伤的重要研究问题，其中的一些方面将推广到其他发展中国家和发达世界。将建立在拉丁美洲进行脑外伤研究的可持续能力。在LABIC的结构内，一批专业人员将接受临床研究方面的培训，他们将有能力开展研究，回答与拉丁美洲相关且重要的问题。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得出他们自己的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.