Common Data Elements for Concussion in Tertiary Care: Phase One in Ontario

AbstractBackground:Standardized data collection for traumatic brain injury (TBI) (including concussion) using common data elements (CDEs) has strengthened clinical care and research capacity in the United States and Europe. Currently, Ontario healthcare providers do not collect uniform data on adult patients diagnosed with concussion.Objective:The Ontario Concussion Care Strategy (OCCS) is a collaborative network of multidisciplinary healthcare providers, brain injury advocacy groups, patient representatives, and researchers with a shared vision to improve concussion care across the province, starting with the collection of standardized data.Methods:The International Framework of Functioning Disability and Health was selected as the conceptual framework to inform the selection of CDEs. The CDEs recommended by the OCCS were identified using key literature, including the National Institute of Neurological Disorders and Stroke–Zurich Consensus Statements for concussion in sport and the Ontario Neurotrauma Foundation Concussion/mTBI clinical guidelines.Results:The OCCS has recommended and piloted CDEs for Ontario that are readily available at no cost, clinically relevant, patient friendly, easy to interpret, and recognized by the international scientific community.Conclusions:The implementation of CDEs can help to shift Ontario toward internationally recognized standard data collection, and in so doing yield a more comprehensive evidence-based approach to care while also supporting rigorous research.

Download Full-text

Challenges to the Standardization of Trauma Data Collection in Burn, Traumatic Brain Injury, Spinal Cord Injury, and Other Trauma Populations: A Call for Common Data Elements for Acute and Longitudinal Trauma Databases

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2018.10.004 ◽

2019 ◽

Vol 100 (5) ◽

pp. 891-898

Author(s):

Laura C. Simko ◽

Liang Chen ◽

Dagmar Amtmann ◽

Nicole Gibran ◽

David Herndon ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Brain Injury ◽

Data Collection ◽

Common Data Elements ◽

Cord Injury ◽

Data Elements

Download Full-text

The TRACK-TBI Approach: Redefining Severity and Outcome Assessments

Neurotrauma ◽

10.1093/med/9780190279431.003.0008 ◽

2018 ◽

pp. 81-100

Author(s):

John K. Yue ◽

Ethan A. Winkler ◽

Hansen Deng ◽

Amy J. Markowitz ◽

Kevin K. W. Wang ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Pilot Study ◽

Data Collection ◽

Large Scale ◽

Diagnostic Tools ◽

Common Data Elements ◽

Diagnostic Approaches ◽

Prospective Trials ◽

Data Elements

Advances in traumatic brain injury (TBI) research have been limited by imprecise classification and diagnostic approaches and insensitive outcome measures. The National Institute of Neurological Disorders and Stroke TBI Common Data Elements (CDEs) project aimed to standardize data collection across TBI research, discover new diagnostic tools, and develop a multidimensional outcomes endpoint sensitive to differential profiles of recovery. Progress from implementing the TBI CDEs is described via the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot (TRACK-TBI Pilot) study. Refinements to the TBI CDEs are incorporated into several ongoing large-scale prospective trials comprising a comprehensive, harmonized dataset capable of refining severity markers and outcome endpoints.

Download Full-text

The nonsurgical nature of patients with subarachnoid or intraparenchymal hemorrhage associated with mild traumatic brain injury

Journal of Neurosurgery ◽

10.3171/2014.10.jns132713 ◽

2015 ◽

Vol 123 (3) ◽

pp. 649-653 ◽

Cited By ~ 19

Author(s):

Benjamin J. Ditty ◽

Nidal B. Omar ◽

Paul M. Foreman ◽

Daxa M. Patel ◽

Patrick R. Pritchard ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Average Distance ◽

Clinical Care ◽

Tertiary Care ◽

Altered Mental Status ◽

The United States ◽

Intraparenchymal Hemorrhage ◽

Gcs Score

OBJECT Mild traumatic brain injury (mTBI), as defined by Glasgow Coma Scale (GCS) score of 13 or higher, is a common problem in the United States and worldwide, estimated to affect more than 1 million patients yearly. When associated with intracranial hemorrhage, it is a common reason for neurosurgical consultation and transfer to tertiary care centers. The authors set out to investigate the clinical implications of subarachnoid hemorrhage (SAH) and/or intraparenchymal hemorrhage (IPH) associated with mTBI in hopes of standardization of mTBI clinical care and optimization of resource allocation. METHODS The authors performed a retrospective review of 500 consecutively treated patients with mTBI and SAH and/or IPH admitted to a Level I trauma center in Alabama between May 2003 and May 2013. They performed a review of medical records to confirm the diagnosis, determine neurological condition at admission, and assess for episodes of neurological decline or brain injury–related complications including altered mental status, seizures, and hyponatremia. RESULTS Of the 500 patients for whom data were reviewed, 304 (60.8%) were male and 196 (39.2%) were female. Average age was 46.3 years. Overall, 63 patients (12.6%) had isolated IPH, 411 (82.2%) had isolated SAH, and 26 (5.2%) had radiographic evidence of both IPH and SAH. One hundred forty-five patients (29%) were transferred an average distance of 64.5 miles. The authors identified no patients who experienced neurological worsening during their hospital course. Two patients experienced hyponatremia that required treatment with sodium supplementation. CONCLUSIONS Patients with the constellation of SAH and/or IPH and mTBI do not require neurosurgical consultation, and these findings should not be used as the sole criteria to justify transfer to tertiary referral centers.

Download Full-text

TBI surveillance using the common data elements for traumatic brain injury: a population study

International Journal of Emergency Medicine ◽

10.1186/1865-1380-6-5 ◽

2013 ◽

Vol 6 (1) ◽

Cited By ~ 11

Author(s):

Latha Ganti Stead ◽

◽

Aakash N Bodhit ◽

Pratik Shashikant Patel ◽

Yasamin Daneshvar ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Population Study ◽

Common Data Elements ◽

The Common ◽

Data Elements

Download Full-text

The Emerging Role of Glucagon-like Peptide-1 Receptor Agonists for the Management of NAFLD

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgab578 ◽

2021 ◽

Author(s):

Chandani Patel Chavez ◽

Kenneth Cusi ◽

Sushma Kadiyala

Keyword(s):

Evidence Synthesis ◽

Clinical Care ◽

Treatment Options ◽

Critical Role ◽

Risk Groups ◽

The United States ◽

Multidisciplinary Teams ◽

Consensus Statements ◽

Meta Analyses

Abstract Context The burden of cirrhosis from NAFLD is reaching epidemic proportions in the United States. This calls for greater awareness among endocrinologists, who often see but may miss the diagnosis in adults with obesity or type 2 diabetes mellitus (T2D) who are at the highest risk. At the same time, recent studies suggest that GLP-1RAs are beneficial versus steatohepatitis (NASH) in this population. This minireview aims to assist endocrinologists to recognize the condition and recent work on the role of GLP-1RAs in NAFLD/NASH. Evidence acquisition Evidence from observational studies, randomized controlled trials, and meta-analyses. Evidence Synthesis Endocrinologists should lead multidisciplinary teams to implement recent consensus statements on NAFLD that call for screening and treatment of clinically significant fibrosis to prevent cirrhosis, especially in the high-risk groups (i.e., people with obesity, prediabetes or T2D). With no FDA-approved agents, weight loss is central to their successful management, with pharmacological treatment options limited today to vitamin E (in people without T2D) and diabetes medications that reverse steatohepatitis, such as pioglitazone or GLP-1RA. Recently the benefit of GLP-1RAs in NAFLD, suggested from earlier trials, has been confirmed in adults with biopsy-proven NASH. In 2021, the FDA also approved semaglutide for obesity management. Conclusion A paradigm change is developing between the endocrinologist’s greater awareness about their critical role to curve the epidemic of NAFLD and new clinical care pathways that include a broader use of GLP-1RAs in the management of these complex patients.

Download Full-text

Reexamining COVID-19 Self-Reported Symptom Tracking Programs in the United States: An Updated Framework Synthesis (Preprint)

10.2196/preprints.31271 ◽

2021 ◽

Author(s):

Miranda Lynn Janvrin ◽

Jessica Korona-Bailey ◽

Tracey Pérez Koehlmoos

Keyword(s):

The United States ◽

Time Frame ◽

Vaccine Hesitancy ◽

Demographic Information ◽

Common Data Elements ◽

Intended Audience ◽

The Public ◽

Pandemic Response ◽

Data Elements ◽

Google Search

BACKGROUND Early in the pandemic Koehlmoos et al (2020) completed a framework synthesis of currently available self-reported symptom tracking programs for COVID19. This framework described the programs, partners/affiliates, funding, responses, platform, and intended audience, among other considerations. OBJECTIVE This current study seeks to update the existing framework with the aim of identifying developments in the landscape and highlighting how programs have adapted to changes in pandemic response. METHODS Our team developed a framework to collate information on current COVD19 self-reported symptom tracking programs using the best-framework method. All programs from the previous article were included to document changes. New programs were discovered using a Google search for keywords. The time frame for the search for programs ranges from March 1, 2021, to May 6, 2021. RESULTS We screened 33 programs; 8 were included in our final framework synthesis. We identified multiple common data elements, including demographic information like race, age, gender, and affiliation (all were associated with universities, medical schools, or schools of public health). Dissimilarities included questions regarding vaccination status, vaccine hesitancy, social distancing adherence, testing, and mental health. CONCLUSIONS At this time, the future of self-reported symptom tracking for COVID-19 is unclear. Some sources have speculated that COVID-19 may become a yearly occurrence much like the flu, and if so, the data that these programs generate is still valuable. However, it is unclear if the public will maintain the same level of interest in reporting their symptoms on a regular basis if the COVID19 becomes more routine.

Download Full-text