AUS-TBI: The Australian Health Informatics Approach to Predict Outcomes and Monitor Intervention Efficacy after Moderate-to-Severe Traumatic Brain Injury

Fitzgerald, Melinda; Ponsford, Jennie Louise; Lannin, Natasha A.; O’Brien, Terence J.; Cameron, Peter; Cooper, David J.; Rushworth, Nick; Gabbe, Belinda

doi:10.1089/neur.2022.0002

Cited by 21 publications

(14 citation statements)

References 46 publications

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“…We also recommend increased collaboration between brain injury services and researchers internationally to enhance our collective capacity to recruit sufficiently powered sample sizes to answer key questions of interest. Such steps will consolidate current knowledge and facilitate optimised, evidence-based care for people with TBI in an approach aligned with AUS-TBI, an Australian-based, health informatics initiative aiming to leverage large-scale data resource to individualise care and treatment for people with TBI [ 66 ].…”

Section: Discussionmentioning

confidence: 99%

The effect of physical activity on health outcomes in people with moderate-to-severe traumatic brain injury: a rapid systematic review with meta-analysis

et al. 2023

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Background In 2020, the World Health Organization (WHO) released the first global physical activity and sedentary behaviour guidelines for children and adults living with disability. The evidence informing the guidelines though is not specific to people living with traumatic brain injury (TBI), but rather comes from other disabling conditions such as Parkinson’s disease, and stroke. There remains a clear lack of direct evidence of the effects of physical activity for people living with TBI. The objective of this rapid review was to identify direct evidence of the effect of physical activity on health outcomes in people with moderate-to-severe TBI to inform adaptation of the WHO physical activity guidelines into clinical practice guidelines. Methods We conducted a rapid systematic review with meta-analysis of randomised controlled trials, including people of any age with moderate-to-severe TBI, investigating physical activity interventions compared to either usual care, a physical activity intervention with different parameters, or a non-physical activity intervention. Four databases (CENTRAL, SPORTDiscus, PEDro, Ovid MEDLINE) were searched from inception to October 8, 2021. The primary outcomes were physical function, cognition, and quality of life. Results Twenty-three studies were included incorporating 812 participants (36% females, majority working-age adults, time post-TBI in studies ranged from 56 days (median) to 16.6 years (mean)). A range of physical activity interventions were evaluated in rehabilitation (n = 12 studies), community (n = 8) and home (n = 3) settings. We pooled data from the end of the intervention for eight outcomes. Participation in a virtual reality physical activity intervention improved mobility, assessed by the Community Balance and Mobility Scale (range 0 to 96; higher score indicates better mobility) more than standard balance training (two studies, 80 participants, Mean Difference = 2.78, 95% CI 1.40 to 4.16; low certainty evidence). There was uncertainty of effect for the remaining outcomes, limited by small sample sizes, diverse comparators and a wide range of outcome measures. Conclusion This review consolidates the current evidence base for the prescription of physical activity for people with moderate-to-severe TBI. There remains a pressing need for further rigorous research in order to develop practice guidelines to support clinical decision-making when prescribing physical activity in this population.

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Section: Discussionmentioning

confidence: 99%

The effect of physical activity on health outcomes in people with moderate-to-severe traumatic brain injury: a rapid systematic review with meta-analysis

et al. 2023

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“…The AUS-TBI Initiative will consider each domain of the TBI experience as a separate study area. 29 The study areas are: 1) demographic, injury event, and social characteristics; 2) pre-existing health conditions; 3) the clinical experience; 4) biological mechanisms; 5) acute interventions; and 6) long-term outcomes. Methods within each study area have overall coherence under the Initiative and vary to meet the requirements of the scientific, clinical, and consumer contexts of each domain.…”

Section: Discussionmentioning

confidence: 99%

“…The Australian Traumatic Brain Injury Initiative (AUS-TBI) is a collaboration of clinicians, scientists, and persons with lived experience seeking to improve prediction, healthcare, and outcomes for persons experiencing moderate-severe TBI. 29 AUS-TBI is designing a coherent, federated, health informatics approach for the collection, management, and use of information about moderate-severe TBI in Australia. This approach is intended to facilitate improved understanding of the TBI experience for use in outcome prediction 30 , 31 and treatment evaluation.…”

Section: Introductionmentioning

confidence: 99%

“…After the systematic review, this article reports the methods subsequently chosen for AUS-TBI and introduces the thematic study areas through which the data dictionary was compiled. Accompanying articles in this series report the further activities in the six study areas, 29 with a summative report of the AUS-TBI data dictionary in the final article.…”

Section: Introductionmentioning

confidence: 99%

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The Australian Traumatic Brain Injury Initiative: Statement of Working Principles and Rapid Review of Methods to Define Data Dictionaries for Neurological Conditions

Bagg,

Hicks,

Hellewell

et al. 2024

Neurotrauma Reports

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The Australian Traumatic Brain Injury Initiative (AUS-TBI) aims to develop a health informatics approach to collect data predictive of outcomes for persons with moderate-severe TBI across Australia. Central to this approach is a data dictionary; however, no systematic reviews of methods to define and develop data dictionaries exist to-date. This rapid systematic review aimed to identify and characterize methods for designing data dictionaries to collect outcomes or variables in persons with neurological conditions. Database searches were conducted from inception through October 2021. Records were screened in two stages against set criteria to identify methods to define data dictionaries for neurological conditions (International Classification of Diseases, 11th Revision: 08, 22, and 23). Standardized data were extracted. Processes were checked at each stage by independent review of a random 25% of records. Consensus was reached through discussion where necessary. Thirty-nine initiatives were identified across 29 neurological conditions. No single established or recommended method for defining a data dictionary was identified. Nine initiatives conducted systematic reviews to collate information before implementing a consensus process. Thirty-seven initiatives consulted with end-users. Methods of consultation were “roundtable” discussion ( n = 30); with facilitation ( n = 16); that was iterative ( n = 27); and frequently conducted in-person ( n = 27). Researcher stakeholders were involved in all initiatives and clinicians in 25. Importantly, only six initiatives involved persons with lived experience of TBI and four involved carers. Methods for defining data dictionaries were variable and reporting is sparse. Our findings are instructive for AUS-TBI and can be used to further development of methods for defining data dictionaries.

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“…Moderate to severe traumatic brain injury (msTBI) is a leading cause of death and disability and is a significant global public health problem 1. In Australia, approximately 20 000 patients a year are admitted to hospitals with msTBI 2. Unfortunately, short-term in-hospital mortality for severe TBI remains static at around 25%–30%, and many surviving patients suffer permanent neurological disability3 despite management in well-resourced, integrated healthcare systems such as Australia.…”

Section: Introductionmentioning

confidence: 99%

PRECISION-TBI: a study protocol for a vanguard prospective cohort study to enhance understanding and management of moderate to severe traumatic brain injury in Australia

Jeffcote,

Battistuzzo,

Plummer

et al. 2024

BMJ Open

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IntroductionTraumatic brain injury (TBI) is a heterogeneous condition in terms of pathophysiology and clinical course. Outcomes from moderate to severe TBI (msTBI) remain poor despite concerted research efforts. The heterogeneity of clinical management represents a barrier to progress in this area. PRECISION-TBI is a prospective, observational, cohort study that will establish a clinical research network across major neurotrauma centres in Australia. This network will enable the ongoing collection of injury and clinical management data from patients with msTBI, to quantify variations in processes of care between sites. It will also pilot high-frequency data collection and analysis techniques, novel clinical interventions, and comparative effectiveness methodology.Methods and analysisPRECISION-TBI will initially enrol 300 patients with msTBI with Glasgow Coma Scale (GCS) <13 requiring intensive care unit (ICU) admission for invasive neuromonitoring from 10 Australian neurotrauma centres. Demographic data and process of care data (eg, prehospital, emergency and surgical intervention variables) will be collected. Clinical data will include prehospital and emergency department vital signs, and ICU physiological variables in the form of high frequency neuromonitoring data. ICU treatment data will also be collected for specific aspects of msTBI care. Six-month extended Glasgow Outcome Scores (GOSE) will be collected as the key outcome. Statistical analysis will focus on measures of between and within-site variation. Reports documenting performance on selected key quality indicators will be provided to participating sites.Ethics and disseminationEthics approval has been obtained from The Alfred Human Research Ethics Committee (Alfred Health, Melbourne, Australia). All eligible participants will be included in the study under a waiver of consent (hospital data collection) and opt-out (6 months follow-up). Brochures explaining the rationale of the study will be provided to all participants and/or an appropriate medical treatment decision-maker, who can act on the patient’s behalf if they lack capacity. Study findings will be disseminated by peer-review publications.Trial registration numberNCT05855252.

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AUS-TBI: The Australian Health Informatics Approach to Predict Outcomes and Monitor Intervention Efficacy after Moderate-to-Severe Traumatic Brain Injury

Cited by 21 publications

References 46 publications

The effect of physical activity on health outcomes in people with moderate-to-severe traumatic brain injury: a rapid systematic review with meta-analysis

The effect of physical activity on health outcomes in people with moderate-to-severe traumatic brain injury: a rapid systematic review with meta-analysis

The Australian Traumatic Brain Injury Initiative: Statement of Working Principles and Rapid Review of Methods to Define Data Dictionaries for Neurological Conditions

PRECISION-TBI: a study protocol for a vanguard prospective cohort study to enhance understanding and management of moderate to severe traumatic brain injury in Australia

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