Defining New Research Questions and Protocols in the Field of Traumatic Brain Injury through Public Engagement: Preliminary Results and Review of the Literature.

Shumaila Hasan,Chris Uff,Mario Ganau,Aswin Chari

doi:10.1155/2019/9101235

Abstract

Traumatic brain injury (TBI) is the most common cause of death and disability in the age group below 40 years. The financial cost of loss of earnings and medical care presents a massive burden to family, society, social care, and healthcare, the cost of which is estimated at £1 billion per annum (about brain injury (online)). At present, we still lack a full understanding on the pathophysiology of TBI, and biomarkers represent the next frontier of breakthrough discoveries. Unfortunately, many tenets limit their widespread adoption. Brain tissue sampling is the mainstay of diagnosis in neuro-oncology; following on this path, we hypothesise that information gleaned from neural tissue samples obtained in TBI patients upon hospital admission may correlate with outcome data in TBI patients, enabling an early, accurate, and more comprehensive pathological classification, with the intent of guiding treatment and future research. We proposed various methods of tissue sampling at opportunistic times: two methods rely on a dedicated sample being taken; the remainder relies on tissue that would otherwise be discarded. To gauge acceptance of this, and as per the guidelines set out by the National Research Ethics Service, we conducted a survey of TBI and non-TBI patients admitted to our Trauma ward and their families. 100 responses were collected between December 2017 and July 2018, incorporating two redesigns in response to patient feedback. 75.0% of respondents said that they would consent to a brain biopsy performed at the time of insertion of an intracranial pressure (ICP) bolt. 7.0% replied negatively and 18.0% did not know. 70.0% would consent to insertion of a jugular bulb catheter to obtain paired intracranial venous samples and peripheral samples for analysis of biomarkers. Over 94.0% would consent to neural tissue from ICP probes, external ventricular drains (EVD), and lumbar drains (LD) to be salvaged, and 95.0% would consent to intraoperative samples for further analysis.

Highlights

Traumatic brain injury (TBI) is the most common cause of death and disability in the age group below 40 years. 1.4 million people attend Emergency Departments (ED) with a recent head injury annually in England and Wales alone [1]
In cases where there is a haematoma amenable to surgical evacuation, patients may undergo a craniotomy or craniectomy to decompress the brain. us, current therapeutic options are limited to relieving pressure and supporting the patient with Intensive Care Units (ICU) care [5]
95.0% would agree to have intraoperative samples being taken, both from blood at the Question Brain attached to intracranial pressure (ICP) tip cerebrospinal fluid (CSF) from drainage bag Neural tissue attached to external ventricular drain (EVD)/lumbar drain tip Peripheral blood tests

Summary

Introduction

Traumatic brain injury (TBI) is the most common cause of death and disability in the age group below 40 years. 1.4 million people attend Emergency Departments (ED) with a recent head injury annually in England and Wales alone [1]. Primary injury cannot be modulated once the injury has occurred, but the focus of TBI care is on preventing or attenuating secondary injury. E 2016 Brain Trauma Foundation Guidelines [4] advocate management of severe diffuse TBI conservatively in Intensive Care Units (ICU) with neuroprotective measures, guided by intracranial pressure (ICP) monitoring, with the potential to provide cerebrospinal fluid (CSF) drainage by Emergency Medicine International inserting an external ventricular drain (EVD) if the ICP remains high. Us, current therapeutic options are limited to relieving pressure (by evacuating haematomas, removing bone, or draining CSF) and supporting the patient with ICU care [5]. Despite many trials there are still no therapeutic options which alter the TBI, and treatment centres on supporting the patient while the brain injury runs its course

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