Collaborative research led by Professor Peter Hutchinson and Professor David Menon has the potential to revolutionise the treatment of traumatic brain injury by identifying the best methods of treatment.
Professor Peter Hutchinson
Department of Clinical Neurosciences
Professor David Menon
Department of Medicine
Arising from multiple causes such as transport accidents, assaults, falls or sporting injuries, traumatic brain injury (TBI) affects 10 million people a year worldwide and is the leading cause of death and disability in children and young adults. However, both the pattern of brain damage between patients and the eventual outcome are highly variable – making it extremely difficult to link particular characteristics of a TBI to optimum treatment and improved outcomes.
As an incredibly complex disease in our most complex organ, research in TBI needs to bridge traditional disciplines to understand brain injury – and crucially, needs to collect a robust evidence base at scale in order to identify the most effective treatments. This is the approach taken by neurotrauma research at Cambridge, which spans the Divisions of Neurosurgery, led by Professor Peter Hutchinson, and Anaesthesia, led by Professor David Menon.
To link diagnosis, treatment and outcome following brain injury, Professor Hutchinson and his group have developed a combined monitoring technology to measure brain pressure, oxygenation and chemistry, explaining that, “A better understanding of brain injury puts us in the best possible position to improve patient outcomes and to shed light on effective treatments.”
The team also led international studies to assess novel treatments, including the RESCUE studies to evaluate the role of decompressive craniectomy in TBI. This surgical procedure removes a section of the skull to reduce intracranial pressure – the most common cause of acute hospital death and major on-going disability after a serious TBI. In order to establish a robust evidence base for the procedure, the RESCUEicp trial carefully evaluated patient outcome, enrolling 408 patients from 52 centres in 20 countries around the world. The trial demonstrated lower rates of mortality and severe disability associated with decompressive craniectomy when compared against standard medical treatment.
“International collaboration is vital to characterise TBI as a disease and to identify the most effective clinical interventions,” explains Menon. With this in mind, the neurotrauma team are participating in the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) project, which aims to provide large-scale evidence on which to base best practice treatment. In total, data will be collected for 20,000–30,000 patients, including extremely detailed data for over 5,000 patients, allowing both detailed and statistically powerful analyses.
Further afield, the team have also set up the Global Health Research Group on Neurotrauma in collaboration with colleagues and partners in low and middle income countries (LMICs). This initiative will translate these major gains in the management of TBI to improve the prevention, investigation, treatment and outcome of head-injured patients in LMICs.
This collaborative research provides an unparalleled opportunity to refine both the clinical characterisation of TBI and to develop individually targeted care. Professor Hutchinson concludes, “There are many treatments that show promise. If we can move to a more personalised approach for TBI, based on knowledge of which treatment works best for whom and under what circumstances, these studies could benefit millions of people.”
Hutchinson PJ et al. NEJM 2016; 375(12):1119-1130
Maas AI et al. Neurosurgery 2015; 76(1):67-80
This work is supported by the Academy of Medical Sciences, the European Commission, the Evelyn Trust, Health Foundation, NIHR and the NIHR Cambridge Biomedical Research Centre, MRC and the Royal College of Surgeons of England.