Supporting Improved Clinical Decision-Making in Severe Traumatic Brain Injury Through Greater Accuracy and Precision of Neurobehavioral Common Data Elements
Abstract
Our proposal will address the Fiscal Year 2021 (FY21) Traumatic Brain Injury and Psychological Health Research Program (TBIPHRP) Clinical Research Development Award (CRDA) Focus Areas related to recovery of function and improvement of long-term outcomes for patients with disorders of consciousness by developing a clinical decision-making tool that incorporates an objective assessment, identifying responders and non-responders to treatment and rehabilitation, and proposing a future clinical research stepped wedge implementation study. Advances in science have resulted in many survivors of traumatic brain injury living in disordered states of consciousness for up to two decades. Consequently, we have not advanced the state of the science to foster traumatic brain injury survivor’s functional recovery. A critical challenge in identifying treatments that facilitate recovery of consciousness is robust and precise measurement. Currently, disorders of consciousness results in significant ambiguity surrounding diagnosis and prognosis. The state of our science results in 40% of patients being misdiagnosed to a lower state of consciousness, such as the vegetative state, when in fact the individual is in a minimally conscious state. Our preliminary studies have shown that the consensus-based Aspen criteria, aligned to the Coma Recovery Scale-Revised, may not suggest all potential criteria for determining the minimally conscious state or emerging from the minimally conscious state. During the FY21 TBIPHRP CRDA, we will validate our preliminary findings on a large, secondary dataset from the Traumatic Brain Injury Model Systems database and the Federal Interagency Traumatic Brain Injury Research Informatics System database. We will determine cut-points for each state of consciousness that identifies everyone who is the state of consciousness with the most neurobehavioral function, requiring a higher sensitivity. We focus on a higher sensitivity because individuals who are diagnosed as being in the minimally conscious state or higher receive access to more healthcare services, such as inpatient rehabilitation. We will also determine indices of responsiveness that will discern when a patient has made a true change beyond measurement error. The output from this preparatory activity will give providers data to determine whether a medication or rehabilitation approach is resulting in progress for the patient. Or should the patient make a decline that is beyond measurement error, this measurement information will prompt the provider to consider alternative rationales for decline such as hydrocephalus or a sedative medication. Our second preparatory goal is to delineate between patient subgroups that have similar functional recovery trajectories. Current evidence describes patients making progress 5 and 10 years post-injury. We need to identify the patient characteristics of individuals that create a subgroup because it will improve a provider’s ability to discuss prognosis with family caregivers. These measurement outputs will complement an existing Recovery Ruler. The Recovery Ruler prototype provides a visual display of Coma Recovery Scale-Revised assessment results, includes prompts for the provider to ask person-centered questions, and has a supplemental form for tracking recovery over time. This Recovery Ruler prototype was developed considering person-centered measurement principles in collaboration with rehabilitation providers and family caregivers. The third goal is to develop a future clinical research study that implements the Recovery Ruler in clinical practice to determine whether it improves communication between providers and family caregivers when making clinical decisions. The future clinical research study aims to see whether the Recovery Ruler (1) fosters communication between caregivers and providers, (2) offers providers clinically useful information about recovery of consciousness, and (3) improves diagnosis using emp
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2210925
Entities
People
- Jennifer A Weaver
Organizations
- Colorado State University
- United States Army