Classification of traumatic brain injury for targeted therapies
| Autor: | Pramod Dash, Gordon Murray, Juan Sahuquillo, Ewout Steyerberg, Lindsay Wilson, Ramon Diaz-Arrastia, Andrew I.R. Maas, Nino Stocchetti, David Wright |
|---|---|
| Přispěvatelé: | Workshop Scientific Team and Advisory Panel Members, Neurosurgery |
| Rok vydání: | 2008 |
| Předmět: |
Diagnostic Imaging
medicine.medical_specialty Endpoint Determination Traumatic brain injury Clinical Neurology Psychological intervention Poison control Review Diagnosis Differential Disability Evaluation Physical medicine and rehabilitation Injury prevention medicine Animals Humans Glasgow Coma Scale Intensive care medicine Stroke Clinical Trials as Topic Trauma Severity Indices business.industry Head injury medicine.disease Clinical trial Disease Models Animal Brain Injuries Data Interpretation Statistical Neurology (clinical) Human medicine business |
| Zdroj: | Journal of neurotrauma Saatman, K E, Duhaime, A-C, Bullock, R, Maas, A I R, Valadka, A, Manley, G T & Murray, G 2008, ' Classification of traumatic brain injury for targeted therapies ', Journal of Neurotrauma, vol. 25, no. 7, pp. 719-38 . https://doi.org/10.1089/neu.2008.0586 Journal of Neurotrauma, 25(7), 719-738. Mary Ann Liebert Inc. |
| ISSN: | 1557-9042 0897-7151 |
| DOI: | 10.1089/neu.2008.0586 |
| Popis: | The heterogeneity of traumatic brain injury (TBI) is considered one of the most significant barriers to finding effective therapeutic interventions. In October, 2007, the National Institute of Neurological Disorders and Stroke, with support from the Brain Injury Association of America, the Defense and Veterans Brain Injury Center, and the National Institute of Disability and Rehabilitation Research, convened a workshop to outline the steps needed to develop a reliable, efficient and valid classification system for TBI that could be used to link specific patterns of brain and neurovascular injury with appropriate therapeutic interventions. Currently, the Glasgow Coma Scale (GCS) is the primary selection criterion for inclusion in most TBI clinical trials. While the GCS is extremely useful in the clinical management and prognosis of TBI, it does not provide specific information about the pathophysiologic mechanisms which are responsible for neurological deficits and targeted by interventions. On the premise that brain injuries with similar pathoanatomic features are likely to share common pathophysiologic mechanisms, participants proposed that a new, multidimensional classification system should be developed for TBI clinical trials. It was agreed that preclinical models were vital in establishing pathophysiologic mechanisms relevant to specific pathoanatomic types of TBI and verifying that a given therapeutic approach improves outcome in these targeted TBI types. In a clinical trial, patients with the targeted pathoanatomic injury type would be selected using an initial diagnostic entry criterion, including their severity of injury. Coexisting brain injury types would be identified and multivariate prognostic modeling used for refinement of inclusion/exclusion criteria and patient stratification. Outcome assessment would utilize endpoints relevant to the targeted injury type. Advantages and disadvantages of currently available diagnostic, monitoring, and assessment tools were discussed. Recommendations were made for enhancing the utility of available or emerging tools in order to facilitate implementation of a pathoanatomic classification approach for clinical trials. |
| Databáze: | OpenAIRE |
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