Skip to main content

Currently Skimming:

7 Gaps, Challenges, and Opportunities
Pages 143-162

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.


From page 143...
... GAPS AND CHALLENGES IN CURRENT TBI CARE AND RESEARCH People who experience TBI and their families need to receive the best possible medical care, be prepared for the nature of the injury and the likely course of recovery, and receive rehabilitation services that address postinjury symptoms and enable a return to the greatest possible level of preinjury function. To meet these needs, health care providers must be able to identify accurately whether a person has experienced a TBI (diagnosis)
From page 144...
... Panel discussion during virtual workshop for the Committee on Accelerating Progress in Traumatic Brain Injury Research and Care, March 18, 2021.
From page 145...
... Panel discussion during virtual workshop for the Committee on Accelerating Progress in Traumatic Brain Injury Research and Care, March 18, 2021. 3 Perrin, P., and J
From page 146...
... Yet TBI care is currently episodic, and care transitions represent an opportunity for mistakes to be made. Patients and families often are left to navigate specialized services that are confusing and difficult to find and do not share data with other services.
From page 147...
... Panel discussion during virtual workshop for the Committee on Accelerating Progress in Traumatic Brain Injury Research and Care, March 18, 2021.
From page 148...
... 6. Gaps in the knowledge base informing best practices and evidence-based acute care As described in Chapter 5, further evidence and clinical guidance are needed on aspects of acute TBI care, especially when a patient has concomitant injuries or confounding comorbidities.
From page 149...
... ° Would incorporating point-of-care testing for approved blood biomarkers, such as glial fibrillary acidic protein (GFAP, a structural protein found in astro cytes) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1, a highly abundant enzyme found in neuronal cell bodies)
From page 150...
... Presentations and panel discussion during virtual workshop for the Committee on Accelerating Progress in Traumatic Brain Injury Research and Care, March 16 and March 18, 2021.
From page 151...
... Panel discussion during virtual workshop for the Committee on Accelerating Progress in Traumatic Brain Injury Research and Care, March 30, 2021. 7 See also https://www.polytrauma.va.gov/system-of-care/index.asp (accessed August 31, 2021)
From page 152...
... The ability to conduct research outside of acute inpatient settings remains challenging, but is essential to advancing TBI care and research. Relevant settings include prehospital environments, EDs, and outpatient rehabilitation and home and community services locations.
From page 153...
... , Traumatic Brain Injury Center of Excellence (TBI CoE) , Regional Amputation Center (RAC)
From page 154...
... was established in 2005, modeled after the NTDB; it incorporates subregistries, including one for TBI. The VA's Traumatic Brain Injury Veterans Health Registry collects information on Veterans with a TBI-related diagnostic code who served in Iraq or Afghanistan, applied for VA disability benefits, and/or screened positive for TBI on the screening assessment administered when a Veteran seeks VA health care.
From page 155...
... Large EHR providers such as EPIC, Cerner, and Meditech are estimated to provide software to almost threequarters of the hospital market.11 In addition, the VA is in the process of a large-scale EHR modernization effort,12 due to be completed by 2028, whose purpose is to create a connected EHR across DoD and VA medical centers and facilitate connections with community care providers. These efforts provide valuable opportunities to establish within EHR systems the collection of standardized patient information needed to support research on TBI care and outcomes.
From page 156...
... The lack of demonstrated effectiveness for TBI therapies in randomized controlled trials supports the need for more precise recruitment of participants into trials designed to test the efficacy of these therapies. Lumping heterogeneous patient populations together for recruitment into clinical trials and evaluation of trial results has made it challenging to demonstrate effectiveness.
From page 157...
... Implementing improved, multimodal approaches for classifying patients could provide the opportunity for more precise targeting and monitoring of care, as well as more successful translation of therapies from the bench to the bedside. Making Greater Use of All Types of Study Designs The TBI field will need to use multiple research design tools, beyond randomized controlled trials, to improve the evidence base in a manner that also allows for implementation
From page 158...
... Panel discussion during virtual workshop for the Committee on Accelerating Progress in Traumatic Brain Injury Research and Care, March 18, 2021.
From page 159...
... 2021. "Lessons from Implementation Science." Presentations and panel discussion during virtual workshop for the Committee on Accelerating Progress in Traumatic Brain Injury Research and Care, April 1, 2021, and quoting from Eccles et al., 2012, p.
From page 160...
... Coronado, and WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury.
From page 161...
... 2020. Association of prehospital plasma with survival in patients with traumatic brain injury: A secondary analysis of the PAMPer cluster randomized clinical trial.
From page 162...
... 2021. Administration of valproic acid in clinically approved dose improves neurologic recovery and decreases brain lesion size in swine subjected to hemorrhagic shock and traumatic brain injury.


This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More information on Chapter Skim is available.