TBI-Prognosis Multicenter Prospective Study
Traumatic brain injury (TBI) is the leading cause of death and severe disabilities among adults under 45 years of age. Most deaths following severe traumatic brain injury are related with the decision made by families and medical teams to withdraw life-sustaining therapies. Because severe traumatic brain injury occurs mainly in a young healthy population, this decision is likely to be based on the perception of an unfavorable long-term outcome. However, recent practice guidelines and current knowledge showed that our capacity to accurately predict outcome in this population is limited. Our prior work showed a significant variation in the frequency of life-sustaining therapy withdrawals across Canadian trauma centers. More importantly, a significant proportion of deaths occurred in the first 3 days, a time-period considered by several experts as being relatively premature to accurately predict the patient outcome.
The purpose of the TBI-Prognosis study is to develop a prognostic model and clinical prediction rule by using a multimodal approach of different prognostic indicators and their evolution over time in the acute phase of care.
This study, taking place in 17 Canadian trauma centers, will improve our ability to prognosticate and identify patients who will benefit from aggressive care in the acute phase, and help preventing erroneous evaluation of prognosis that could have lethal consequences when used to decide to pursue or withdraw life-sustaining therapies.
- Turgeon AF, Lauzier F, Simard JF et al.; for the Canadian Critical Care Trials Group. Mortality associated with withdrawal of life-sustaining therapy for patients with severe traumatic brain injury: a Canadian multicentre cohort study. CMAJ. 2011; 183 (14): 1581-1588. PMID 21876014
- Turgeon AF, Lauzier F, Burns K et al.; for the Canadian Critical Care Trials Group. Determination of neurological prognosis in adult patients with severe traumatic brain injury: a survey of Canadian intensivists, neurosurgeons and neurologists. Crit Care Med. 2013; 41(4):1086-93. PMID 23385104
- Cote N, Turgeon AF, Lauzier F et al.; for the Canadian Critical Care Trials Group. Factors Associated with the Withdrawal of Life-Sustaining Therapies in Patients with Severe Traumatic Brain Injury: A Multicenter Cohort Study. Neurocrit Care. 2013; 18(1):154-60. PMID 23099846
- Turgeon AF, Lauzier F, Thibodeau M et al.; and the Canadian Critical Care Trials group. Feasibility of a multicenter prospective pilot study on the evaluation of prognosis in severe traumatic brain injury. Critical Care. 2012; 16(Suppl 1): P310.
- Mercier E, Boutin A, Lauzier F et al. Predictive value of S-100ß protein for prognosis in patients with moderate and severe traumatic brain injury: systematic review and meta-analysis. BMJ. 2013; 346:f1757. PMID 23558282
Enrolment to date
- CHU de Québec - Hôpital de l’Enfant-Jésus (Quebec city, Quebec)
- Hôpital du Sacré-Coeur de Montréal (Montreal, Quebec)
- Centre Hospitalier Universitaire de Sherbrooke (Sherbrooke, Quebec)
- Montreal General (Montreal, Quebec)
- The Ottawa Hospital (Ottawa, Ontario)
- Sunnybrook Health Sciences Center (Toronto, Ontario)
- St-Michael's Hospital (Toronto, Ontario)
- Hamilton Health Sciences Center (Hamilton, Ontario)
- London Health Sciences Center (London, Ontario)
- Winnipeg Health Sciences Center (Winnipeg, Manitoba)
- Foothills Health Sciences Center (Calgary, Alberta)
- Royal Alexandra Hospital (Edmonton, Alberta)
- University of Alberta Hospital (Edmonton, Alberta)
- Vancouver General Hospital (Vancouver, British Columbia)
- Royal Colombian Hospital (New Westminster, British Columbia)
- Royal Jubilee Hospital (Victoria, British Columbia)
- Queen Elizabeth II Health Sciences Center (Halifax, Nova Scotia)