Andrew Ir Maas

..Intense collaboration and interaction between clinicians, basic researchers, IT-experts, nurses and industry will be required to further advance the fields towards more personalized approaches...

..As with therapeutic targets in individual patient management, so it is with research tools: one size does not fit all...

..The aim of this study was to assess the influence of between-centre differences in outcome on the estimated treatment effect in a large RCT in TBI...

..Suggestions are provided for the way forward, with an emphasis on epidemiological monitoring, trauma organisation, and approaches to management...

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..These proposals deserve to be taken forward at an international level. This initiative may well constitute one of the most important steps forwards, paving the road for harvesting successful results in the near future...

..This corresponds to being able to detect a 7% treatment effect with the same number of patients needed to demonstrate a 10% difference with an unadjusted analysis based on the dichotomized Glasgow outcome scale...

..This proposed standardization will facilitate comparison of research findings across studies and encourage high-quality meta-analysis of individual patient data...

..This proposed process of standardization will facilitate comparative effectiveness research and encourage high-quality meta-analysis of individual patient data...

..The objective of this study is to quantify the benefits of ordinal analysis in the real-life situation of a large TBI trial...

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..60-0.78). Higher glucose values were associated with increasing age, but on adjusted analysis, the strength of the association with outcome remained. Whether treatment of abnormal values may improve outcome needs further rigorous study...

..We present technical data including strengths and weaknesses of these systems, information from clinical studies and formulate a vision for the future...

..We conclude that both the CT classification and individual CT characteristics are important predictors of outcome in TBI. For clinical trials, a central review process is advocated to minimize observer variability in CT assessment...

..Recommendations were made for enhancing the utility of available or emerging tools in order to facilitate implementation of a pathoanatomic classification approach for clinical trials...

..Our finding of a smooth relationship with improving outcome as SBP increases up to 135 mm Hg, while not supporting a strong causal inference, does suggest that current guidelines need to be reconsidered...

..To analyze factors determining the time between injury and study drug administration (SDA) in a randomized controlled trial (RCT) of acute severe traumatic brain injury (TBI) and to discuss the ethical implications...

..We aimed to explore observer variation in the assessment of outcome in a recently completed trial of dexanabinol in head injury and to consider steps to reduce such variation...

..To describe the modeling techniques used for early prediction of outcome in traumatic brain injury (TBI) and to identify aspects for potential improvements...

..The time frame during which hemorrhagic expansion occurs provides an opportunity for early intervention to limit a process with adverse prognostic implications...

..An awareness of this procedural error and methods to reduce misclassification should be incorporated in TBI clinical trials...

..3 to 25.1 mm3). The current data therefore suggest that the delayed secondary expansion of a cortical contusion following traumatic brain injury may not be caused by a reduction of CBF alone...

..The high incidence of both outcomes in patients primarily referred support direct admission of more and particularly older patients with severe or moderate brain trauma to level I trauma centers...

..The occurrence of secondary insults prior to or on admission to hospital in TBI patients is strongly related to poorer outcome and should therefore be a priority for emergency department personnel...

..Falls were found to be associated with an older age and with a higher incidence of mass lesions. Following adjustment for age in the analysis, the relationship between cause of injury and outcome was lost...

..The relative benefits of early versus delayed surgery in patients with intraparenchymal lesions and on the indications, technique and benefits of decompressive craniectomy could be topics for future head injury research...

..This classification is increasingly used as a predictor of outcome. We aimed to examine the predictive value of the Marshall CT classification in comparison with alternative CT models...

..The high discriminative ability indicates the potential of this model for classifying patients according to prognostic risk...

..The approach raises issues of clinical, statistical, and regulatory importance, and we initiate what we believe needs to become a widespread debate amongst the community involved in clinical research in head injury and stroke...

..This review has specific reference to traumatic brain injury, and is based on an extensive evaluation of the literature and on expert opinion...

..Further refinements in future research are likely to improve results from transplantation-based treatments for TBI...

..The authors studied the shape and strength of the relationship between age and outcome, that is, the 6-month mortality rate and unfavorable outcome based on the Glasgow Outcome Scale...

..Pathophysiologic evidence warrants targeting therapy for patients with traumatic brain injury and subarachnoid hemorrhage toward improvement of cerebral oxygenation guided by continuous monitoring of brain tissue oxygen tension...

..The goal of this study was to examine what regional differences in patient characteristics, case management, and outcomes exist between continents and among countries within a patient population included in a randomized clinical trial...

..We critically reviewed the use of two types of secondary analyses, covariate adjustment and subgroup analysis, which are common in TBI trials...

..Traumatic brain injury is a major cause of death and disability. We sought to assess the safety and efficacy of dexanabinol, a synthetic cannabinoid analogue devoid of psychotropic activity, in severe traumatic brain injury...

..0001). Pupil reactivity was more robust between these time points. It is recommended that the study hospital enrollment GCS and pupil reactivity be used for prognostic analysis...

..We conclude that outcome following TBI is dependent on age, race, to a lesser extent on education, but not on gender...

..Many of our approaches are based on simple graphical displays of the data, but, where appropriate, we have also used methods that although established in the statistical literature are relatively novel in their application to TBI...

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..A major reduction in sample size can be obtained with covariate adjustment in TBI trials. Covariate adjustment for strong predictors should be incorporated in the analysis of future TBI trials...

..CONCLUSIONS: The number of actual and potential organ donors is declining, but a considerable number of potential CNHB donors exists. Refusal by relatives is the most important reason for failure to procure organs...

..The satisfactory discrimination indicates that logistic regression models, developed on large samples, can be used for classifying TBI patients according to prognostic risk...

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