Standardizing Data Collection in Traumatic Brain Injury

Abstract

Collaboration among investigators, centers, countries, and disciplines is essential to advancing the care for traumatic brain injury (TBI). It is thus important that we ''speak the same language.'' Great variability, however, exists in data collection and coding of variables in TBI studies, confounding comparisons between and analysis across different studies. Randomized controlled trials can never address the many uncertainties concerning treatment approaches in TBI. Pooling data from different clinical studies and high-quality observational studies combined with comparative effectiveness research may provide excellent alternatives in a cost-efficient way. Standardization of data collection and coding is essential to this end. Common data elements (CDEs) are presented for demographics and clinical variables applicable across the broad spectrum of TBI. Most recommendations represent a consensus derived from clinical practice. Some recommendations concern novel approaches, for example assessment of the intensity of therapy in severely injured patients. Up to three levels of detail for coding data elements were developed: basic, intermediate, and advanced, with the greatest level of detail attained in the advanced version. More detailed codings can be collapsed into the basic version. Templates were produced to summarize coding formats, explanation of choices, and recommendations for procedures. Endorsement of the recommendations has been obtained from many authoritative organizations. The development of CDEs for TBI should be viewed as a continuing process; as more experience is gained, refinement and amendments will be required. This proposed process of standardization will facilitate comparative effectiveness research and encourage high-quality meta-analysis of individual patient data.

Standardizing ICU management of pediatric traumatic brain injury is associated with improved outcomes at discharge

“…4,5,10,26 There have been numerous studies on the treatment of TBI in the adult population, 4,6,8,9,11,15,16,24,25,29 but less research has been performed on treating TBI in pediatric patients. 2,5,7,18,21,23 These patients' still-maturing CNS responds differently to injury and the current treatments available, making it imperative to determine the best course of action to improve outcomes in this population.…”

“…2,5,7,18,21,23 These patients' still-maturing CNS responds differently to injury and the current treatments available, making it imperative to determine the best course of action to improve outcomes in this population. 5,16,18,22 The 2003 Brain Trauma Foundation guidelines, 5 which were most recently updated in 2012, 14 summarized practice standards for treatment of severe TBI in children. The overarching goal of critical care in treating TBI is to reduce secondary brain injury by limiting cerebral ischemia and optimizing cerebral blood flow.…”

Predicting 14-Day Mortality after Severe Traumatic Brain Injury: Application of the IMPACT Models in the Brain Trauma Foundation TBI-trac® New York State Database

“…We therefore had to modify and refit the IMPACT extended models to include these parameters; we consider it, however, unlikely that this will have influenced performance. The discrepancy in coding essential variables emphasizes the necessity for standardization of data collection in TBI studies, as recommended by the Common Data Elements initiative (Duhaime et al, 2010;Maas et al, 2010bMaas et al, ,2011Manley et al, 2010;Wilde et al, 2010).…”

Call for an Integrative and Multi-Disciplinary Approach to Traumatic Brain Injury (TBI)

“…Lastly, premorbid functioning needs to be considered and estimated by convergent neuropsychological and achievement measures, in order to gain a more accurate measure of current functioning. Given these limitations, many have argued that physiological measures, as neuroimaging and the tracking biological markers, need to be integrated with neuropsychological testing to not only to aid in diagnosis of TBI, but also to monitor recovery and guide treatment (Maas et al, 2011). 3) Brain neuroimaging studies as assessment measures. Neuroimaging techniques that are particular promising in the early detection of brain damage and the changes with TBI are those that measure specific metabolites and neurotransmitters, as with MR Spectroscopy (MRS), or the integrity of white matter tracts with DTI Kou et al, 2010;Van Boven et al, 2009).…”