Despite all the attention being paid to head injuries, methods used to classify and study traumatic brain injury (TBI) are lacking, argued a viewpoint article published Aug. 7 in JAMA. Taxonomies, outcome assessments, a measure of economic effects and sophisticated infrastructure for clinical care and research are all necessary to further understand the condition.
“The complexity of TBI is such that no single investigator, institution, funding organization, or private company can make progress on its own,” wrote Geoffrey T. Manley, MD, PhD, of the University of California, San Francisco, and Andrew I. R. Maas, MD, PhD, of the University of Antwerp, Belgium. “Traumatic brain injury needs a broad-based, sustainable, multidisciplinary approach aimed at elucidating mechanisms of TBI biology, identifying risk factors, and developing treatments.”
A number of basic questions have been left unanswered, according to Manley and Maas, including which individuals with TBI will develop postconcussive syndrome, when athletes can safely return to play after a head injury and even whether a brain injury has actually occurred.
Failures to develop clinical trials to answer these questions stem from a classification system for TBI that is severely limited, wrote the authors. Broad classifications such as mild, moderate or severe TBI don’t incorporate newly discovered imaging biomarkers, and the Glasgow Outcome Scale-Extended measure of outcomes is global, insensitive and doesn’t allow for mechanistic targeting for clinical trials.
Manley and Maas pointed to some important first steps at improving TBI research. In response to calls from the U.S. National Institute of Neurological Disorders and Stroke, U.S. Department of Defense and the National Institute on Disability and Rehabilitation Research, expert panels were convened to coordinate future research efforts. These panels developed the TBI Common Data Elements, which cover clinical, imaging, biospecimen and outcomes data, allowing for collection of information across sites and across the injury spectrum.
The European Commission and Canadian Institutes of Health Research have both announced recipients for funding related to the International Initiative for TBI Research, and President Barack Obama recently unveiled the BRAIN Initiative. Manley and Maas wrote that the first steps of these efforts should be longitudinal studies following the natural history of TBI to identify promising avenues for research.
“Traumatic brain injury research and clinical care are decades behind other diseases, such as cancer and cardiovascular disease, and there is an important need to close existing knowledge gaps,” they wrote.