Less than half of all the people who sustain a mild traumatic brain injury (mTBI), also referred to as a concussion, and are evaluated at U.S. Level 1 trauma centers receive the follow-up care they often need. Even of those mTBI patients with a ‘positive’ head CT, only 39% are sent home from the hospital with such straightforward interventions as educational materials or instructions about worrisome symptoms. This missed opportunity to support the patient’s recovery may have longstanding impact. At 12 months post-injury, and even beyond, some mTBI patients report an array of symptoms that impact life as they knew it before their injury – including headache, dizziness, poor sleep, mood change, and cognitive or memory deficits.

Recent research from the One Mind-supported Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study has shown that head CT scans can identify the common types of intracranial injury that definitively identify an mTBI, that a number of them frequently present together, and that these different “phenotypes” have varying implications for outcome up to a year after the injury.

As recently published in JAMA Neurology, the TRACK-TBI research team “determined and externally validated the distribution, patterns, and importantly, clinical significance of intracranial CT findings in a large prospective longitudinal observational cohort” that can accurately estimate the prognostic significance of individual CT features in mTBI. TRACK-TBI is a longitudinal observational study that has enrolled over 3,000 participants with TBI and matched controls via a network of 18 U.S.-based Level 1 trauma centers. The study has collected clinical head CT scans within 24 hours of injury and a range of other clinical, biologic, neuroimaging, and genomic measures at 2 weeks and at 3, 6, and 12 months post-injury.

The findings were given even greater strength, as the TRACK-TBI authors externally validated their findings in a wholly separate dataset, the One Mind-supported CENTER-TBI study, which enrolled TBI patients at 65 European trauma centers.

As noted by TRACK-TBI Contact Principal Investigator and study co-author, Dr. Geoff Manley of UCSF, “Our ability to conduct TRACK-TBI and this advanced analysis, was hugely facilitated by One Mind’s vision and early championing of the idea to co-design these two large studies.”

One Mind has given $2.7M to TRACK-TBI and $1.6M to CENTER-TBI, and has also provided strategic formulatory support to both studies. This includes playing a key role in endorsing their use of the National Institutes of Health-National Institute of Neurological Disorders and Stroke’s Common Data Elements in their data collection protocols, as deemed optimal by InTBIR, the International Initiative for TBI Research. InTBIR is a collaborative effort of the European Commission, the Canadian Institutes of Health Research and the NIH, established in October 2011 to advance clinical TBI research, treatment and care.

As a result of the TRACK-TBI’s confirmation of these key neuroimaging biomarkers, clinicians have the strongest evidence yet to immediately aid in the triage of the nearly 5 million patients in the U.S. alone who visit an emergency room for evaluation of a head injury.

Said Dr. Manley, “Having this objective, nearly universally accessible prognostic information from the CT scan – the tool we consider the ‘workhorse of the emergency department’ – should spur our emergency department colleagues to provide the TBI-specific education and systematic follow up these patients need to improve their ability to make a complete recovery.”