Traumatic Brain Injury

Traumatic Brain Injury (TBI) is a major cause of mortality and disability, both in High Income Countries (HIC) and Low and Middle Income Countries (LMIC). The World Monitor AdjustmentHealth Organization’s (WHO) Global Burden of Disease Reports indicate Latin America has the highest incidence of intracranial injury worldwide due to high rates of road traffic crashes and violence. A recent WHO study projected trauma would be a leading cause of death by the year 2020. TBI accounts for about 85% of all trauma-related fatalities.

The negative consequences of severe TBI are not limited to mortality. The rate of disabilities among survivors is high. Severe brain injury has the potential to impair all major areas of functioning, including various aspects of cognition (e.g., memory, judgment), physical abilities (e.g., disturbance of balance, ambulation), and to cause behavioral problems such as irritability, lack of initiative, and depression. These deficits, in turn, oftentimes hinder the person with a brain injury from functioning effectively in everyday life (e.g. work, independent living, self-care, social relationships). 

Since 2007, the University of Washington (UW), with collaborators from the Oregon Health and Science University, the University of California, San Diego, Argentina, Bolivia, Ecuador, Colombia, and Brazil have been conducting a Randomized Controlled Trial (RCT) evaluating management of severe TBI using intracranial pressure (ICP) monitoring in the intensive care unit (ICU) at six sites in two countries. In addition an observational study in 5 countries has focused on natural course of recovery and outcome. In the observational study, ICP monitoring varied by site but, overall, was used in a minority of patients. UW Professor Randall Chesnut, MD is Principal Investigator for the overall research program which is funded by an NIH NINDS/Fogarty sponsored grant “Traumatic Brain Injury in Latin America: Lifespan Analysis”. The studies are run in collaboration with Fundacion ALAS (Apoyo al Lesionado Neurologico Agudo – “Support to the Acute Neurological Patient“), and the Latin American Brain Injury Consortium (LABIC).

In addition to the ongoing grant, the team has conducted 3 other multinational multisite studies with LABIC investigators. Two were funded by the US and one was sponsored by Fundacion ALAS the Argentine non-profit fiscal and administrative collaborator for LABIC. The purpose of LABIC is to organize and coordinate interactions among Neurointensivists from countries throughout Latin America, provide Neurointensive care education via courses for nurses, physicians, and associated care providers, coordinate Neurointensive Care sections within Latin American national and international conferences (e.g. Critical Care Conferences, Internal Medicine Conferences, Neurosurgical Conferences), translate important Neurointensive Care documents into Spanish and Portuguese, write and disseminate Neurointensive Care literature to Latin American practitioners, develop national and international research activities and provide a unified voice for interactions with international medical and scientific societies. Current membership includes approximately 300 individuals representing 50 institutions from 12 Latin American countries.

Traumatic Brain InjuryA new project entitled “Managing severe TBI without ICP monitoring - guidelines development and testing” is now under review for funding by the Fogarty International Center and the National Institute of Neurological Disorders and Stroke.  If funded, this project would develop consensus based guidelines for managing TBI in the absence of ICP monitoring devices found in most HICs.  These guidelines are important because TBI is treated without ICP monitoring in most LMIC countries due to resource limitations.