Addenbrooke’s doctor leads first-of-its-kind UK study on treatment for children with traumatic brain injuries
Addenbrooke’s doctor Dr Shruti Agrawal has led the UK’s first multi-centre study of its kind designed to improve outcomes for children with traumatic brain injuries.
The leading cause of death and disability in children worldwide, traumatic brain injury leads to long-term problems for two thirds of survivors.
The most severely injured are managed by monitoring their blood and brain pressure to set treatment targets.
But outcomes can be improved by individualising targets using real-time analysis of routinely collected data. This is called “continuous assessment of cerebrovascular autoregulation (CA) using pressure reactivity index (PRx)”.
However, there has been concern that data on the subject is inadequate, as experience with cerebrovascular autoregulation monitoring in paediatric traumatic brain injury is limited to single-centre studies, or looking back at past events.
The new study was carried out across 10 UK Paediatric Intensive Care Units (PICUs) over five years and focused on 135 children under 16 years and explored many factors associated with favourable outcomes, unfavourable outcomes and deaths.
The aim was to identify critical thresholds of PRx in relation to outcome and create a research database.
Called STARSHIP (Status of Cerebrovascular AutoRegulation relates to outcome in Severe Paediatric Head Injury), the significant findings support PRx monitoring for fine-tuning treatment targets with the potential to improve outcomes.
The improved data resource will be available to third-party investigators, aiding collaboration and further research.
Dr Agrawal, a paediatric intensivist and paediatric trauma lead at Cambridge University Hospitals, said: “Understanding the underpinning principles and management of raised intracranial pressure and brain perfusion is essential for reducing the morbidity and mortality of traumatic brain injuries.
“Our study has many strengths, the most important being the prospective multicentre design with a predefined sample size and protocol. Given the paucity of such evidence and data, STARSHIP database offers a unique opportunity of ongoing research and data collection.
“We are indebted to all the patients and their families for participation in this study, to the staff in the PICUs for their contribution, all those affiliated to this work, and our funders, sponsors and supporters.”
Among the patients taking part in the study was 18-year-old Mia Jack, from Soham, who has spent six years in recovery following a horrific accident on a quadbike during a family activity day.
Mia said: “Anything that helps with traumatic brain injury in children – and raises awareness of it at the same time – has got to be a good thing.”
The study was funded by Action Medical Research for Children and Addenbrooke’s Charitable Trust (ACT), sponsored by Cambridge University Hospitals NHS Foundation Trust, and supported by the National Institute of Health Research (NIHR) Cambridge Biomedical Research Centre and the NIHR Clinical Research Network.
The findings were published in the international medical research journal, eClinicalMedicine, last Thursday.
ACT chief executive officer, Shelly Thake, said: “We were delighted to be able to help fund this important study, which was only possible thanks to the generosity of our incredible supporters, some of whom will unfortunately have direct experience of the challenges associated with traumatic brain injury in children.”
Dr Caroline Johnston, senior research manager, Action Medical Research, added: “Funding research to further our understanding of traumatic brain injury and the long-term consequences is important and brings hope to children and their families. We are delighted to have partnered with Addenbrooke's Charitable Trust to work towards improving the understanding and treatment of severe traumatic brain injuries in children.”
Cambridge University Hospitals NHS Foundation Trust is working on building a dedicated children’s hospital for the Eastern region on Cambridge Biomedical Campus, which will combine physical and mental healthcare under one roof.
