Microvascular Barrier Biomarkers to Predict ICP Therapeutic Intensity After Severe TBI
Abstract
Severe traumatic brain injury (TBI) is a leading cause of death and disability, and often occurs at the same time as multiple other injuries and with and without bleeding. Current care of the patient with a brain injury is designed to avoid factors that cause the initial injury to become worse (low blood pressure and lack of oxygen). Our proposal seeks to identify early laboratory measures that can predict whether a patient is likely to get worse, then treat the causes of the condition to improve outcomes at 6 months after injury. The ultimate goal is to be able to use a simple blood test that identifies the degraded components in the brain to rapidly identify the subset of severe TBI patients that require high intensity care. We expect that the laboratory tests will predict brain swelling and whether the patient will require higher levels of care. We also expect that if the brain-injured patient is also bleeding, the patient will be worse than if the patient had a brain injury without bleeding. To accomplish this goal, we will use continuous brain monitoring to define three levels of deterioration that predict poor outcomes or a need for high intensity treatment. These data will be correlated with laboratory values in the early post-injury period. Brain imaging will also be evaluated. These early data will be correlated with a score that measures the functional recovery of the patient at 6 months after the injury and other imaging that can measure injury-related tissue loss. This project will enroll patients in two clinical observational studies. Study 1 is a descriptive pilot study that will enroll 25 consecutive severe TBI patients and develop and validate the tools to define the levels of patient deterioration and represents Phase 1 of this project. Study 2 is also an observational study that will enroll 50 consecutive severe TBI patients and encompasses Phases 2 and 3 of this project. Phase 2 is focused on the patient deterioration determined by laboratory values. Phase 3 will correlate these laboratory values with patient outcomes defined by imaging and assessment of function. Because these studies are observational, treatment of the patient will not change during the study and therefore there is minimal additional risk to the patient due to the study. Benefits include increased monitoring of patients enrolled in these studies, but treatment benefits will only occur in future patients. By being able to accurately and acutely predict severe TBI patients who may develop rapid progression to a malignant intracranial pressure phenotype, military patients in Forward Surgical or En Route Critical Care could be rapidly triaged to facilities with neurosurgical capabilities, and/or aggressively monitored for complications. This project should produce a tool that rapidly predicts civilian or military patients who will require high-intensity neurocritical care and identify a group of patients for future aggressive interventions in order to improve outcomes in this group of patients.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Nov 19, 2019
- Source ID
- W81XWH1910539
Entities
People
- C. E. Cox
Organizations
- United States Army
- University of Texas Health Science Center at Houston