̽��ֱ�� of Cambridge - brain injury

Advanced MRI scans help identify one in three concussion patients with ‘hidden disease’

cjb250 — Thu, 08 Aug 2024 22:30:10 +0000

Around one in 200 people in Europe every year will suffer concussion. In the UK, more than 1 million people attend Emergency Departments annually with a recent head injury. It is the most common form of brain injury worldwide.

When a patient in the UK presents at an Emergency Department with head injury, they are assessed according to the NICE head injury guidelines. Depending on their symptoms, they may be referred for a CT scan, which looks for brain injuries including bruising, bleeding and swelling.

However, CT scans identify abnormalities in fewer than one in 10 patients with concussion, yet 30-40% of patients discharged from the Emergency Department following a scan experience significant symptoms that can last for years and be potentially life-changing. These include severe fatigue, poor memory, headaches, and mental health issues (including anxiety, depression, and post-traumatic stress).

Dr Virginia Newcombe from the Department of Medicine at the ̽��ֱ�� of Cambridge and an Intensive Care Medicine and Emergency Physician at Addenbrooke’s Hospital, Cambridge, said: “ ̽��ֱ��majority of head injury patients are sent home with a piece of paper telling them the symptoms of post-concussion to look out for and are told to seek help from their GP if their symptoms worsen.

“ ̽��ֱ��problem is that the nature of concussion means patients and their GPs often don’t recognise that their symptoms are serious enough to need follow-up. Patients describe it as a ‘hidden disease’, unlike, say, breaking a bone. Without objective evidence of a brain injury, such as a scan, these patients often feel that their symptoms are dismissed or ignored when they seek help.”

In a study published today in eClinicalMedicine, Dr Newcombe and colleagues show that an advanced form of MRI known as diffusion tensor imaging (DTI) can substantially improve existing prognostic models for patients with concussion who have been given a normal CT brain.

DTI measures how water molecules move in tissue, providing detailed images of the pathways, known as white matter tracts, that connect different parts of the brain. Standard MRI scanners can be adapted to measure this data, which can be used to calculate a DTI ‘score’ based on the number of different brain regions with abnormalities.

Dr Newcombe and colleagues studied data from more than 1,000 patients recruited to the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study between December 2014 and December 2017. 38% of the patients had an incomplete recovery, meaning that three months after discharge their symptoms were still persisting.

̽��ֱ��team assigned DTI scores to the 153 patients who had received a DTI scan. This significantly improved the accuracy of the prognosis – whereas the current clinical model would correctly predict in 69 cases out of 100 that a patient would have a poorer outcome, DTI increased this to 82 cases out of 100.

dti_images_web.jpg

Whole brain diffusion tensor tractography showing healthy patient (left) and patient at two days (centre) and six weeks (right) after severe traumatic brain injury (Credit: Virginia Newcombe)

̽��ֱ��researchers also looked at blood biomarkers – proteins released into the blood as a result of head injury – to see whether any of these could improve the accuracy of the prognosis. Although the biomarkers alone were not sufficient, concentrations of two particular proteins – glial fibrillary acidic protein (GFAP) within the first 12 hours and neurofilament light (NFL) between 12 and 24 hours following injury – were useful in identifying those patients who might benefit from a DTI scan.

Dr Newcombe said: “Concussion is the number one neurological condition to affect adults, but health services don’t have the resources to routinely bring back every patient for a follow-up, which is why we need a way of identifying those patients at greatest risk of persistent symptoms.

“Current methods for assessing an individual’s outlook following head injury are not good enough, but using DTI – which, in theory, should be possible for any centre with an MRI scanner – can help us make much more accurate assessments. Given that symptoms of concussion can have a significant impact on an individual’s life, this is urgently needed.”

̽��ֱ��team plan to look in greater details at blood biomarkers, to see if they can identify new ways to provide even simpler, more practical predictors. They will also be exploring ways to bring DTI into clinical practice.

Dr Sophie Richter, a NIHR Clinical Lecturer in Emergency Medicine and first author, Cambridge, added: “We want to see if there is a way to integrate the different types of information obtained when a patient presents at hospital with brain injury – symptoms assessment, blood tests and brain scans, for example – to improve our assessment of a patient’s injury and prognosis.”

̽��ֱ��research was funded by European Union's Seventh Framework Programme, Wellcome and the National Institute for Health and Care Excellence.

Reference
Richter, S et al. Predicting recovery in patients with mild traumatic brain injury and a normal CT using serum biomarkers and diffusion tensor imaging (CENTER-TBI): an observational cohort study. eClinMed; 8 Aug 2024; DOI: 10.1016/j.eclinm.2024.102751

Offering patients with concussion a type of brain scan known as diffusion tensor imaging MRI could help identify the one in three people who will experience persistent symptoms that can be life changing, say Cambridge researchers.

Concussion is the number one neurological condition to affect adults, which is why we need a way of identifying those patients at greatest risk of persistent symptoms

Virginia Newcombe

Callista Images (Getty Images)

Diffusion tensor imaging (DTI) MRI of the human brain - stock photo

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Cambridge to lead new research platform to transform treatment of traumatic brain injury in the UK

cjb250 — Wed, 28 Jun 2023 00:00:22 +0000

Traumatic brain injury, or TBI, is a leading cause of death and disability in people under 40 in the UK and can cause a range of serious and lifelong health issues for people who survive, including dementia, epilepsy and poor mental health.

Until now, data collected by individual research projects investigating TBI has rarely been used outside the original study, even though it provides a potentially rich resource for understanding TBI and advancing its clinical care. This lack of coordinated use of data has slowed progress in treating and caring for people experiencing TBI.

To address this, the MRC, the National Institute for Health and Care Research (NIHR), the Ministry of Defence and Alzheimer’s Research UK are jointly funding this initiative to establish a UK-wide research platform, TBI-REPORTER, which will be led by the ̽��ֱ�� of Cambridge.

TBI-REPORTER will bring together leading experts from across the UK to enable research into TBI, including concussion, and across the lifespan from children to older ages. It will also support research in previously under studied populations, including prisoners, homeless people and victims of domestic violence.

To do this, TBI-REPORTER will collaborate with Health Data Research UK (HDR UK) and build on successes of wider NHS and population-based UK research, such as UK Biobank and Dementias Platform UK (DPUK), to bring together rich datasets from existing studies in TBI. It will also coordinate research data collection and clinical studies going forward, and all of this will be made available to UK and international researchers to accelerate research in TBI and its impact on lifelong health.

̽��ֱ��hope is that this will lead to more people being treated effectively as doctors are able to better predict how a certain injury is likely to affect a patient with TBI and offer them individualised care.

̽��ֱ��platform will also assist academic and industrial partners to develop better diagnostic tests and treatments for TBI. To facilitate this, the TBI-REPORTER platform will establish a network of research-ready NHS specialist neuroscience hospitals primed to trial innovative ways of diagnosing and treating TBI.

Brain injury survivor James Piercy said: “As one of the estimated 1 million people living with the results of a traumatic brain injury, I welcome this new initiative which promises to improve diagnosis and treatment of TBI: the ‘hidden disability’.”

Project lead Professor David Menon, Head of the Division of Anaesthesia at the ̽��ֱ�� of Cambridge, said: “It is a privilege to lead this ambitious platform, which brings together a breadth of experts and draws on the lived experience of TBI survivors and their families, to improve care of traumatic brain injury. We also believe that our work, in combination with that of international partners, will re-energise drug development in TBI and deliver new treatments for patients.”

Secretary of State for Science, Innovation and Technology Chloe Smith said: “Traumatic brain injuries are a leading cause of death and disability in people under 40 in the UK and survivors often endure a lifetime of physical, emotional, and cognitive challenges.

“This funding will bring together leading experts and support studies into the long-term consequences of traumatic brain injuries, allowing researchers to identify patterns and develop tailored treatments, with the potential of saving and massively improving the lives of those with such injuries. It is yet another example of how the UK’s science sector is improving treatment and health outcomes for Britons across the country.”

Professor John Iredale, Executive Chair of the MRC, part of UKRI, added: “We recognise the devastating impacts traumatic brain injury can have for its survivors and those who care for them, and are determined to improve the status quo. This award will capitalise on the UK’s unique scientific strengths to see research into TBI accelerated on a scale not seen before. This will lead to the discoveries we need to give survivors of TBI all around the world a much more hopeful future.”

Dr Susan Kohlhaas, Director of Research at Alzheimer’s Research UK, said: “Over a million people in the UK are living with long-term symptoms of a traumatic brain injury, and evidence suggests that exposure to such an injury can increase dementia risk. At Alzheimer’s Research UK, we believe it is only by bringing people from different backgrounds together through collaborative approaches that we’ll begin to solve the major challenges in treatment and diagnosis of TBIs. ̽��ֱ��TBI-REPORTER programme will be fundamental in improving our understanding of how brain injury contributes to dementia risk so we can prevent dementia in the future.”

TBI-REPORTER represents a collaboration of leading institutions from across the UK, and will be coordinated by the Universities of Cambridge, Glasgow and Sheffield, Imperial College London, and Swansea ̽��ֱ��. It also includes close engagement with the public, patients, and their families through the United Kingdom Acquired Brain Injury Forum (UKABIF).

Cambridge is to lead a £9.5m research platform that aims to transform the way survivors of traumatic brain injury are diagnosed and treated in the UK, the Medical Research Council (MRC) announced today.

It is a privilege to lead this ambitious platform, which brings together a breadth of experts and draws on the lived experience of TBI survivors and their families, to improve care of traumatic brain injury

David Menon

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Almost half of people with concussion still show symptoms of brain injury six months later

cjb250 — Tue, 25 Apr 2023 23:00:34 +0000

Mild traumatic brain injury – concussion – results from a blow or jolt to the head. It can occur as a result of a fall, a sports injury or from a cycling accident or car crash, for example. But despite being labelled ‘mild’, it is commonly linked with persistent symptoms and incomplete recovery. Such symptoms include depression, cognitive impairment, headaches, and fatigue.

While some clinicians in recent studies predict that nine out of 10 individuals who experience concussion will have a full recovery after six months, evidence is emerging that only a half achieve a full recovery. This means that a significant proportion of patients may not receive adequate post-injury care.

Predicting which patients will have a fast recovery and who will take longer to recover is challenging, however. At present, patients with suspected concussion will typically receive a brain scan – either a CT scan or an MRI scan, both of which look for structural problems, such as inflammation or bruising – yet even if these scans show no obvious structural damage, a patient’s symptoms may still persist.

Dr Emmanuel Stamatakis from the Department of Clinical Neurosciences and Division of Anaesthesia at the ̽��ֱ�� of Cambridge said: “Worldwide, we’re seeing an increase in the number of cases of mild traumatic brain injury, particularly from falls in our ageing population and rising numbers of road traffic collisions in low- and middle-income countries.

“At present, we have no clear way of working out which of these patients will have a speedy recovery and which will take longer, and the combination of over-optimistic and imprecise prognoses means that some patients risk not receiving adequate care for their symptoms.”

Dr Stamatakis and colleagues studied fMRI brain scans – that is, functional MRI scans, which look at how different areas of the brain coordinate with each other – taken from 108 patients with mild traumatic brain injury and compared them with scans from 76 healthy volunteers. Patients were also assessed for ongoing symptoms.

̽��ֱ��patients and volunteers had been recruited to CENTER-TBI, a large European research project which aims to improve the care for patients with traumatic brain injury, co-chaired by Professor David Menon (head of the division of Anaesthesia) and funded by the European Union.

In results published today in Brain, the team found that just under half (45%) were still showing symptoms resulting from their brain injury, with the most common being fatigue, poor concentration and headaches.

̽��ֱ��researchers found that these patients had abnormalities in a region of the brain known as the thalamus, which integrates all sensory information and relays this information around the brain. Counter-intuitively, concussion was associated with increased connectivity between the thalamus and the rest of the brain – in other words, the thalamus was trying to communicate more as a result of the injury – and the greater this connectivity, the poorer the prognosis for the patient.

Rebecca Woodrow, a PhD student in the Department of Clinical Neuroscience and Hughes Hall, Cambridge, said: “Despite there being no obvious structural damage to the brain in routine scans, we saw clear evidence that the thalamus – the brain’s relay system – was hyperconnected. We might interpret this as the thalamus trying to over-compensate for any anticipated damage, and this appears to be at the root of some of the long-lasting symptoms that patients experience.”

By studying additional data from positron emission tomography (PET) scans, which can measure regional chemical composition of body tissues, the researchers were able to make associations with key neurotransmitters depending on which long-term symptoms a patient displayed. For example, patients experiencing cognitive problems such as memory difficulties showed increased connectivity between the thalamus and areas of the brain rich in the neurotransmitter noradrenaline; patients experiencing emotional symptoms, such as depression or irritability, showed greater connectivity with areas of the brain rich in serotonin.

Dr Stamatakis, who is also Stephen Erskine Fellow at Queens' College, Cambridge, added: “We know that there already drugs that target these brain chemicals so our findings offer hope that in future, not only might we be able to predict a patient’s prognosis, but we may also be able to offer a treatment targeting their particular symptoms.”

Reference
Woodrow, RE et al. Acute thalamic connectivity precedes chronic postconcussive symptoms in mild traumatic brain injury. Brain; 26 April 2023; DOI: 10.1093/brain/awad056

Even mild concussion can cause long-lasting effects to the brain, according to researchers at the ̽��ֱ�� of Cambridge. Using data from a Europe-wide study, the team has shown that for almost a half of all people who receive a knock to the head, there are changes in how regions of the brain communicate with each other, potentially causing long term symptoms such as fatigue and cognitive impairment.

̽��ֱ��combination of over-optimistic and imprecise prognoses means that some patients risk not receiving adequate care for their symptoms

Emmanuel Stamatakis

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International study recommends replacing skull section after treatment for a brain bleed

cjb250 — Sun, 23 Apr 2023 19:30:09 +0000

̽��ֱ��RESCUE-ASDH trial, funded by the UK’s National Institute for Health and Care Research (NIHR), involved 40 centres in 11 countries and involved 450 patients. ̽��ֱ��results of the trial are published today in the New England Journal of Medicine and are announced at the annual meeting of the American Association of Neurological Surgeons.

One of the potentially life-threatening results of head injury is a so-called acute subdural haematoma – a bleed that occurs between the brain and skull and can lead to the build-up of pressure. Such haemorrhages require surgery to stem the bleeding, remove the blood clot and relieve the pressure.

At present, there are two approaches to such surgery. One approach is a decompressive craniectomy, which involves leaving a section of the skull out – which can be as large as 13cm in length – in order to protect the patient from brain swelling, often seen with this type of haemorrhage. ̽��ֱ��missing skull typically will need to be reconstructed and in some treatment centres, the patient’s own bone will be replaced several months after surgery, while at other centres a manufactured plate is used.

̽��ֱ��second approach is a craniotomy, in which the skull section is replaced after the haemorrhage has been stemmed and the blood clot removed. This approach will obviate the need for a skull reconstruction further down the line.

To date there has been little conclusive evidence and hence no uniformly accepted criteria for which approach to use. To solve this question, an international team led by researchers at the ̽��ֱ�� of Cambridge and Cambridge ̽��ֱ�� Hospitals NHS Foundation Trust carried out a randomised trial – RESCUE-ASDH – in which patients undergoing surgery for traumatic acute subdural haematoma were randomly assigned to undergo decompressive craniectomy or craniotomy.

A total of 228 patients were assigned to the craniotomy group and 222 to the decompressive craniectomy group. ̽��ֱ��researchers assessed the outcomes for these patients and their quality of life up to a year after surgery, as measured on clinical evaluation scales.

Patients in both groups had similar disability-related and quality-of-life outcomes at 12 months post-surgery, with a trend – which was not statistically significant – towards better outcomes with craniotomy.

Around one in four patients (25.6%) in the craniotomy group and one in five (19.9%) in the decompressive craniectomy group had a good recovery as measured on the scales.

Around one in three patients in both groups (30.2% of patients in the craniotomy group and 32.2% of those in the decompressive craniectomy group) died within the first 12 months following surgery.

14.6% of the craniotomy group and 6.9% of the decompressive craniectomy group required additional cranial surgery within two weeks after randomisation. However, this was balanced against the fact that fewer people in the craniotomy group experienced wound complications (3.9% against 12.2% of the decompressive craniectomy group).

Professor Peter Hutchinson, Professor of Neurosurgery at Cambridge and the trial's Chief Investigator, said: " ̽��ֱ��international randomised trial RESCUE-ASDH is the first multicentre study to address a very common clinical question: which technique is optimal for removing an acute subdural haematoma – a craniotomy (putting the bone back) or a decompressive craniectomy (leaving the bone out)?

“This was a large trial and the results convincingly show that there is no statistical difference in the 12 month disability-related and quality of life outcomes between the two techniques.”

Professor Angelos Kolias, Consultant Neurosurgeon at Cambridge and the trial's Co-chief Investigator, said: "Based on the trial findings, we recommend that after removing the blood clot, if the bone flap can be replaced without compression of the brain, surgeons should do so, rather than performing a pre-emptive decompressive craniectomy.

“This approach will save patients from having to undergo a skull reconstruction, which carries the risk of complications and additional healthcare costs, further down the line.”

̽��ֱ��researchers point out, however, that the findings may not be relevant for resource-limited or military settings, where pre-emptive decompressive craniectomy is often used owing to the absence of advanced intensive care facilities for post-operative care.

Professor Andrew Farmer, Director of NIHR’s Health Technology Assessment (HTA) Programme, said: “ ̽��ֱ��findings of this world-leading trial provide important evidence which will improve the way patients with head injuries are treated. High quality, independently funded research like this is vital in providing evidence to improve health and social care practice and treatments. Research is crucial in informing those who plan and provide care.”

̽��ֱ��RESCUE-ASDH trial was supported by the NIHR Global Health Research Group on Acquired Brain and Spine Injury, the CENTER-TBI project of the European Brain Injury Consortium, and the Royal College of Surgeons of England Clinical Research Initiative.

Reference
Hutchinson, PJ et al. Decompressive Craniectomy versus Craniotomy for Acute Subdural Hematoma. NEJM; 23 Apr 2023; DOI: 10.1056/NEJMoa2214172

A major international trial has concluded that, where possible, surgeons should replace the removed section of the skull following surgery to treat a form of brain haemorrhage. This approach will save patients from having to undergo skull reconstruction further down the line.

This approach will save patients from having to undergo a skull reconstruction, which carries the risk of complications and additional healthcare costs, further down the line

Angelos Kolias

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Bike Crash - Road Traffic Accident

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Traumatic brain injury ‘remains a major global health problem’ say experts

Anonymous — Fri, 30 Sep 2022 00:14:20 +0000

̽��ֱ��report – the 2022 Lancet Neurology Commission – has been produced by world-leading experts, including co-lead author Professor David Menon from the Division of Anaesthesia at the ̽��ֱ�� of Cambridge.

̽��ֱ��Commission documents traumatic brain injury (TBI) as a global public-health problem, which afflicts 55 million people worldwide, costs over US$400 billion (£350 billion) per year, and is a leading cause of injury-related death and disability.

TBI is not only an acute condition but also a chronic disease with long-term consequences, including an increased risk of late-onset neurodegeneration, such as Parkinson’s disease and dementia. Road traffic incidents and falls are the main causes, but while in low- and middle-income countries, road traffic accidents account for almost three times the number of TBIs as falls, in high-income countries falls cause twice the number of TBIs compared to road traffic accidents. These data have clear consequences for prevention.

Over 90% of TBIs are categorized as ‘mild’, but over half of such patients do not fully recover by six months after injury. Improving outcome in these patients would be a huge public health benefit. A multidimensional approach to outcome assessment is advocated, including a focus on mental health and post-traumatic stress disorder. Outcome after TBI is poorer in females compared with males, but reasons for this are not clear.

Professor Menon said: “Traumatic brain injury remains a major global health problem, with substantial impact on patients, families and society. Over the last decade, large international collaborations have provided important information to improve understanding and care of TBI. However, significant problems remain, especially in low and middle income countries. Continued collaborative efforts are needed to continue to improve patient outcomes and reduce the societal impact of TBI.”

̽��ֱ��Commission identified substantial disparities in care, including lower treatment intensity for patients injured by low-energy mechanisms, deficiencies in access to rehabilitation and insufficient follow-up in patients with ‘mild’ TBI. In low- and middle-income countries, both pre-hospital and post-acute care are largely deficient.

̽��ֱ��Commission presents substantial advances in diagnostics and treatment approaches. Blood-based biomarkers perform as well – or perhaps even better – than clinical decision rules for selecting patients with mild TBI for CT scanning, and can thus help reduce unnecessary radiation risks. They also have prognostic value for outcome. Genomic analyses suggests that 26% of outcome variance in TBI might be heritable, emphasizing the relevance of host response, which is modifiable. Advanced monitoring of the brain in patients with severe injuries in the intensive care setting provides better insight into derangements of brain function and metabolism, providing a basis for individualizing management to the needs of a patient. These advances have, however, not yet led to improved outcome. Mortality in patients with moderate to severe injuries appears to have decreased, but a greater number of survivors may have substantial disability.

Emeritus Professor Andrew Maas from the Antwerp ̽��ֱ�� Hospital and ̽��ֱ�� of Antwerp, Belgium, said: “Improving care pathways and removing current disparities in care for patients with TBI will require close collaboration between policymakers, clinicians and researchers, with input from patients and patient representatives.”

Professor Geoffrey Manley from the ̽��ֱ�� of California, San Francisco and Zuckerberg San Francisco General Hospital and Trauma Center, USA, said: “This Commission represents true team science, involving over 300 authors and contributors from around the globe working closely with the team at Lancet Neurology. Much of the data reported come from large-scale collaborative studies, illustrating the strength of longer-term observational research. There can be no doubt that multidisciplinary international collaboration is the way forward”.

Reference
Lancet Neurology Commission. Lancet Neurology; 30 Sept 2022; DOI: 10.1016/S1474-4422(22)00309-X

Adapted from a press release from SMC Media.

A new report highlights the advances and challenges in prevention, clinical care, and research in traumatic brain injury, a leading cause of injury-related death and disability worldwide.

Over the last decade, large international collaborations have provided important information to improve understanding and care of TBI. However, significant problems remain, especially in low and middle income countries

David Menon

Tashi-Delek (Getty Images)

Firefighters At A Car Accident Scene

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

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Largest ever study on traumatic brain injury highlights global inequality in causes and treatment

cjb250 — Wed, 16 Mar 2022 23:30:44 +0000

̽��ֱ��Global Neurotrauma Outcomes Study, funded by the NIHR, is published in ̽��ֱ��Lancet Neurology and provides data to assist in decision making and improving outcome for patients with traumatic brain injury globally.

̽��ֱ��paper focuses on types of cases, the way they are managed, and death rates, and was compiled using data submitted by 159 hospitals in 57 countries to a central database, which the researchers then analysed. ̽��ֱ��researchers stratified countries into four tiers (very high, high, medium, low) according to their Human Development Index (HDI), which takes account of factors like life expectancy, education, and income.

̽��ֱ��prospective study determined that patients in the low HDI tier were often young and tended to suffer skull fractures due to assault but were classified as ‘mild’ traumatic brain injury (TBI).

In the medium and high HDI tiers, patients were also young, but most had moderate to severe TBI caused by a road traffic collision and extradural haematoma – a bleed on the outside of the dura mater, the membrane covering of the brain.

In the very high tier, patients tended to be older and presented with a moderate or severe TBI associated with a fall and acute subdural haematoma - a bleed on the inner surface of the dura mater.

Image: Map showing most common causes of traumatic brain injury: fall, road traffic collision (RTC), and assault.

Quality of care was generally less favourable in lower HDI settings, including delays to surgery and a lack of postoperative monitoring equipment and intensive care. ̽��ֱ��very high HDI tier had the highest proportion of operations in which the most senior surgeon present in the operating theatre was a fully qualified neurosurgeon, while the medium HDI tier had the lowest proportion. ̽��ֱ��study also found significant variations between hospitals in the outcome of patients.

Angelos Kolias, Consultant Neurosurgeon at Cambridge ̽��ֱ�� Hospitals NHS Foundation Trust (CUH) and NIHR Global Neurotrauma Research Group associate director, said: “ ̽��ֱ��results show that overall mortality is low, reflecting the life-saving nature of surgery for traumatic brain injuries. Many of these patients would have died without an operation. However, we also need to address deficits in pre-hospital management and long-term rehabilitation.”

David Clark, a trainee neurosurgeon and ̽��ֱ�� of Cambridge research fellow, said: “A particularly important finding is that outcome is influenced more by hospital characteristics than country of origin, which raises the possibility that changing the systems and processes of care in individual hospitals might be able to improve mortality. ̽��ֱ��paper sows the seeds for discussion and change.”

̽��ֱ��research was funded by the NIHR using UK government aid to support global health research.

Alexis Joannides, Consultant Neurosurgeon at CUH and NIHR Global Neurotrauma Research Group informatics lead, added: “ ̽��ֱ��contribution of several clinicians and researchers from several hospitals across the world has been possible due to the infrastructure and collaborations supported by the NIHR.

“ ̽��ֱ��database and data management process used in the study have now laid the foundation for a global registry of traumatic brain injuries that we have established to support ongoing quality improvement and research in the field of traumatic brain injury.”

Peter Hutchinson, Professor of Neurosurgery at the ̽��ֱ�� of Cambridge and Director of the NIHR Global Neurotrauma Research Group, said: “This is the largest study in the world looking at the surgical management of head injuries and will be of practical value to clinicians and others planning strategies for the future.

“ ̽��ֱ��collaboration across such a vast number of hospitals and countries, together with the support of the World Federation of Neurosurgical Societies and continental neurosurgical societies, has been phenomenal.”

Reference
Clark, D et al. Casemix, management, and mortality of patients receiving emergency neurosurgery for traumatic brain injury in the Global Neurotrauma Outcomes Study: a prospective observational cohort study. ̽��ֱ��Lancet Neurology; 17 March 2022; DOI: 10.1016/S1474-4422(22)00037-0

Adapted from a press release from Cambridge ̽��ֱ�� Hospitals NHS Foundation Trust

Neurosurgery experts from Cambridge have led the largest ever study examining the surgical management of traumatic brain injuries, highlighting regional inequalities in both major causes and treatment of such injuries.

This is the largest study in the world looking at the surgical management of head injuries and will be of practical value to clinicians and others planning strategies for the future

Peter Hutchinson

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Common drug for build-up of blood following head injury worse than placebo, study finds

cjb250 — Wed, 16 Dec 2020 22:00:11 +0000

Chronic subdural haematoma is one of the most common neurological disorders and mainly affects older people. People affected often have headaches, deteriorating memory, confusion, balance problems or limb weakness. Surgery to drain the liquid collection is effective with the majority of patients improving.

A commonly used steroid, dexamethasone, has been used alongside surgery or instead of it since the 1970s. However, consensus has been lacking regarding the use of dexamethasone, especially since no high-quality studies confirming its effectiveness had been conducted until now.

With funding from the UK National Institute Health Research, a group of doctors and researchers from 23 neurosurgical units in the United Kingdom enrolled 748 patients with chronic subdural haematoma in the “Dexamethasone in Chronic Subdural Haematoma (Dex-CSDH)” randomised trial. A total of 375 patients were randomised to receive a two-week tapering course of dexamethasone and were compared with 373 patients randomised to an identical matching placebo.

̽��ֱ��results of the study, published today in the New England Journal of Medicine, show that patients who received dexamethasone had a lower chance of favourable recovery at six months compared to patients who received placebo. More specifically, the vast majority of patients in both groups had an operation to drain the haematoma and had experienced significant functional improvement at six months compared to their initial admission to hospital.

Fewer patients in the dexamethasone group required repeat surgery for a recurrent haematoma compared to patients in the placebo group. However, 84% of patients who received dexamethasone had recovered well at 6 months compared to 90% of patients who received placebo.

Peter Hutchinson, Professor of Neurosurgery at the ̽��ֱ�� of Cambridge and the trial’s Chief Investigator, said: “Chronic subdural haematoma has been steadily increasing in frequency over the past decades. Patients affected are often frail and have other co-existing medical conditions. Since the 1970s, dexamethasone has been used as a drug alongside or instead of surgery with a few studies reporting good results.

“Our trial sought to determine if dexamethasone should be offered routinely to all patients with chronic subdural haematoma or if its use should be abandoned. Based on our findings, we believe that dexamethasone should not be used in patients with chronic subdural haematoma anymore.”

Angelos Kolias, Lecturer of Neurosurgery at the ̽��ֱ�� of Cambridge and the trial’s Co-chief Investigator, added: “ ̽��ֱ��results of the study were surprising given that dexamethasone seemed to help reduce the number of repeat surgeries. However, this simply reinforces the importance of conducting high-quality trials with patient-reported outcomes as the main outcomes of interest”.

Ellie Edlmann, the trial’s research fellow, currently a Clinical Lecturer at the ̽��ֱ�� of Plymouth, concluded: “Credit is due to all doctors and researchers from across the NHS who worked tirelessly in order to enrol all eligible patients in the trial; in particular, the role of trainee neurosurgeons, members of the British Neurosurgical Trainee Research Collaborative, needs to be highlighted. We sincerely thank all patients and their carers, as without their altruistic participation, this trial would not have been possible.”

̽��ֱ��trial was funded by the National Institute for Health Research (NIHR), with further support from the NIHR Cambridge Biomedical Research Centre, the NIHR Brain Injury MedTech Co-operative, the Royal College of Surgeons of England, and the Rosetrees Trust.

Reference
Hutchinson, PJ et al. Trial of Dexamethasone for Chronic Subdural Hematoma. NEJM; 16 Dec 2020; DOI: 10.1056/NEJMoa2020473

A commonly-used treatment for chronic subdural haematoma – the build-up of ‘old’ blood in the space between the brain and the skull, usually as a result of minor head injury – could lead to a worse outcome than receiving no medication, suggests new research from the ̽��ֱ�� of Cambridge.

Our trial sought to determine if dexamethasone should be offered routinely to all patients with chronic subdural haematoma or if its use should be abandoned. Based on our findings, we believe that dexamethasone should not be used in patients with chronic subdural haematoma anymore

Peter Hutchinson

Raw Pixels

Closeup of brain MRI scan result

Yes

Cambridge team to study concussion in international motorsport

cjb250 — Thu, 21 Feb 2019 13:46:37 +0000

̽��ֱ��RESCUE-RACER study, announced this week, is a two-year study of motorsport concussion, in partnership with world motorsport’s governing body Fédération Internationale de l'Automobile (FIA). It will incorporate the most promising and technologically advanced concussion assessment tools currently available to establish and assess the progression of concussion symptoms in motorsports.

̽��ֱ��study consists of two parts. ̽��ֱ��first investigates 40 UK-based racing drivers at baseline, recruiting mainly from the British Touring Car Championship and its associated series. Post-injury tests are open to international motorsport competitors, to be carried out during the 2019 race season. ̽��ֱ��second part assesses a minimum of 20 drivers in the acute post-injury period (up to three weeks after injury).

̽��ֱ��tests will involve measures such as eye tracking, balance, and reaction time, with data collected using technology developed by Neuro Kinetics, Inc, with whom the researchers are collaborating. ̽��ֱ��team will also collect data using the Cambridge Neuropsychological Test Automated Battery (CANTAB) as well as salivary biomarkers. They will use the latest, powerful 7T functional Magnetic Resonance Imaging (fMRI) scanners, which assess brain activity by measuring changes in blood flow.

̽��ֱ��Principal Investigator for RESCUE-RACER is Professor Peter Hutchinson from Cambridge’s Department of Clinical Neurosciences, and a neurosurgeon at Cambridge ̽��ֱ�� Hospitals NHS Foundation Trust.

“ ̽��ֱ��project represents a significant step for motorsport medicine,” says Professor Hutchinson. “RESCUE-RACER will follow drivers through a racing season and uses state-of-the-art assessment tools and imaging. This represents a tremendous opportunity to improve the management of drivers with concussion and traumatic brain injury in terms of assisting recovery and enabling return to safe driving.”

Primary study support is provided by the FIA’s 2018 Sid Watkins Scholar and RESCUE-RACER Study Coordinator Dr Naomi Deakin. Dr Deakin is a PhD student at Robinson College, where Professor Hutchinson is a fellow and Director of Studies for Clinical Medicine.

̽��ֱ��goal of the study is to establish the progression of symptoms and signs of concussion sustained in motorsport activity using a comprehensive battery of scientific tests by exploring emerging technologies for objective assessments that can assist with concussion diagnosis and prognosis. Improved care for head-injured racers could translate into enhanced care for road-traffic accident victims from the general population.

“After an accident there is obvious concern for the individual racer, but a concussed driver also presents a potentially lethal risk to other competitors as well as spectators and crew,” says Dr Deakin.

“We hope that our study will lead to evidenced-based, medical decision-making protocols for track-side evaluation after potentially concussive incidents, as well as enabling a plan for clinical management of motorsports concussion, including the important ‘return-to-race’ decision.”

̽��ֱ��RESCUE-RACER (Research Evaluating Sports ConcUssion Events – Rapid Assessment of Concussion and Evidence for Return) programme is funded by the FIA Foundation and supported by Neuro Kinetics. It is jointly sponsored by the ̽��ֱ�� of Cambridge and Cambridge ̽��ֱ�� Hospitals NHS Foundation Trust, which comprises Addenbrooke’s Hospital and the Rosie Maternity Hospital.

Adapted from a press release by Neuro Kinetics.

Cambridge researchers are to take part in a study to examine the impact of concussion in motorsports, with the aim of reducing traumatic brain injury and helping drivers recover.

This represents a tremendous opportunity to improve the management of drivers with concussion and traumatic brain injury in terms of assisting recovery and enabling return to safe driving

Peter Hutchinson

British Touring Car Championship (copyright)

Motorsport crash

Yes