Examples of Technical Innovation for Traumatic Brain Injury Prevention, Diagnosis, and Care

Convened April 15, 2024

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Tamara Haag, Chanel Matney, and Katherine Bowman, Rapporteurs

Forum on Traumatic Brain Injury

Board on Health Sciences Policy

Health and Medicine Division

Proceedings of a Workshop

NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by contracts and grants between the National Academy of Sciences and Brain Scope, Inc.; Department of Defense (contract W81XWH22C0033); Department of Veterans Affairs (contract 36C24E22P0005); National Highway Traffic Safety Administration; National Institute on Disability, Independent Living, and Rehabilitation Research (contract 140D0423C0099 through the Department of the Interior); National Institutes of Health (contract HHSN263201800029I, task order 775N98024F00005); Neurotrauma Sciences; American Academy of Nursing; American Academy of Physical Medicine and Rehabilitation; American Association of Neurological Surgeons; American College of Surgeons; American Physical Therapy Association; Brain Injury Association of America; Concussion Legacy Foundation; Emergency Nurses Association; National Association of Emergency Medical Technicians; National Association of State Head Injury Administrators; and National College Athletic Association. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-72991-8
International Standard Book Number-10: 0-309-72991-2
Digital Object Identifier: https://doi.org/10.17226/28258

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2025. Examples of technical innovation for traumatic brain injury prevention, diagnosis, and care: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/28258.

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PLANNING COMMITTEE¹

CHRISTINA L. MASTER (Chair), Professor of Clinical Pediatrics, Children’s Hospital of Philadelphia and University of Pennsylvania

KRISTY ARBOGAST, Scientific Director, Center for Injury Research and Prevention, and R. Anderson Pew Distinguished Chair, Department of Pediatrics, Children’s Hospital of Philadelphia and University of Pennsylvania

RAMON DIAZ-ARRASTIA, John McCrea Dickson M.D. Presidential Professor of Neurology and Director, Clinical TBI Research Initiative, University of Pennsylvania Perelman School of Medicine

ADAM FERGUSON, Director of Data Science; Professor, Department of Neurological Surgery, University of California San Francisco, Zuckerberg San Francisco General Hospital, and San Francisco VA Health Care System

CYNTHIA GROSSMAN, Subject Matter Expert in Health Data, Digital Health, Behavioral Science, Patient Centricity, and Real-World Evidence

FREDERICK KORLEY, Associate Professor of Emergency Medicine, University of Michigan Medical School

MICHELLE LAPLACA, Director, Neurotrauma and Translational Bioengineering Laboratory, and Professor of Biomedical Engineering, Georgia Institute of Technology and Emory University

GEOFFREY SHIU FEI LING, Professor of Neurology and Attending Physician in Neurocritical Care, Johns Hopkins Medical Institutions

CHRISTOPHER LOFTUS, Chief Medical Officer, Office of Neurological and Physical Medicine Devices, U.S. Food and Drug Administration

LUCA MARINELLI, Senior Principal Scientist, Biology and Applied Physics, GE Research, Technology and Innovation Center

CAPT. TRAVIS POLK, Director, Combat Casualty Care Research Program, U.S. Department of Defense

LESLIE S. PRICHEP, Chief Scientific Officer, BrainScope Company, Inc.

Health and Medicine Division Staff

CHANEL MATNEY, Workshop Director and Program Officer, Board on Health Sciences Policy

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¹ The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

GAYATRI SOMAIYA, Senior Program Assistant, Board on Health Sciences Policy

KATHERINE BOWMAN, Forum Director and Senior Program Officer, Board on Health Sciences Policy

CLARE STROUD, Senior Director, Board on Health Sciences Policy

Consultants

ANNA NICHOLSON, Founder and Lead Writer, Doxastic

TAMARA HAAG, Science Writer, Doxastic

FORUM ON TRAUMATIC BRAIN INJURY¹

DONALD BERWICK (Cochair), Institute for Healthcare Improvement

CORINNE PEEK-ASA (Cochair), University of California, San Diego

JOE BONNER, Eunice Kennedy Shriver National Institute of Child Health and Human Development

JOE BRENNAN, Avalon Action Alliance

JAVIER CÁRDENAS, West Virginia University and American Academy of Neurology

JOHN CORRIGAN, Ohio State University and Brain Injury Association of America

JILL DAUGHERTY, Centers for Disease Control and Prevention

RAMON DIAZ-ARRASTIA, University of Pennsylvania Perelman School of Medicine

E. WESLEY ELY, Vanderbilt University Medical Center

BRUCE EVANS, Upper Pine River Fire Protection District and National Association of Emergency Medical Technicians

JONATHAN FISHER, American College of Emergency Physicians

STEVEN FLANAGAN, New York University Grossman School of Medicine and American Academy of Physical Medicine and Rehabilitation

BRIAN HAINLINE, National Collegiate Athletic Association

ODETTE HARRIS, Stanford University School of Medicine and VA Palo Alto Health Care System

RICHARD HODES, National Institute on Aging

STUART HOFFMAN, Department of Veterans Affairs

JAMES KELLY, University of Colorado Anschutz Medical Campus

FREDERICK KORLEY, University of Michigan Medical School

WALTER KOROSHETZ, National Institute of Neurological Disorders and Stroke

RACHEL LAZARUS, AARP

KATHY LEE, Department of Defense

D. CARL LONG, NeuroTrauma Sciences™, LLC

TARA JO MANAL, American Physical Therapy Association

GEOFFREY MANLEY, University of California San Francisco and Zuckerberg San Francisco General Hospital

LUCA MARINELLI, GE Research

CHRISTINA L. MASTER, University of Pennsylvania Perelman School of Medicine and Children’s Hospital of Philadelphia

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¹ The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

BETH MCQUISTON, Abbott Laboratories

CATE MILLER, National Institute on Disability, Independent Living, and Rehabilitation Research

CHRIS NOWINSKI, Concussion Legacy Foundation

KAREN O’CONNELL, Northern Kentucky University School of Nursing and Emergency Nurses Association

TESSIE OCTOBER, Eunice Kennedy Shriver National Institute of Child Health and Human Development

DAVID OKONKWO, University of Pittsburgh School of Medicine

TOLU O. OYESANYA, Duke University School of Nursing

MAYUR B. PATEL, Vanderbilt University Medical Center and American College of Surgeons Committee on Trauma

LESLIE S. PRICHEP, BrainScope Company, Inc.

TERRY RAUCH, Department of Defense

JOEL SCHOLTEN, Department of Veterans Affairs

SHELLY TIMMONS, Indiana University School of Medicine and American Association of Neurological Surgeons

GAMUNU WIJETUNGE, National Highway Traffic Safety Administration

REBECCAH WOLFKIEL, National Association of State Head Injury Administrators

KRISTINE YAFFE, University of California, San Francisco

Forum Staff

KATHERINE BOWMAN, Forum Director

CHANEL MATNEY, Program Officer

GAYATRI SOMAIYA, Senior Program Assistant

CHRISTIE BELL, Finance Business Partner

CLARE STROUD, Senior Director, Board on Health Sciences Policy

Reviewers

This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.

We thank the following individuals for their review of this proceedings:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings, nor did they see the final draft before its release. The review of this proceedings was overseen by AMY K. WAGNER, University of Pittsburgh. She was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies. We also thank staff member CONNIE CITRO for reading and providing helpful comments on this manuscript.

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Contents

ACRONYMS AND ABBREVIATIONS

1 INTRODUCTION

Workshop Objectives

Organization of the Proceedings of the Workshop

2 IMPLEMENTING AN INNOVATION IN TBI CARE: LESSONS LEARNED FROM TBI BIOMARKER DEVELOPMENT AND CONSIDERATIONS FOR PATIENT ENGAGEMENT

Blood-Based Biomarkers for TBI: Conceptualization to Implementation and Barriers to Widespread Adoption

Patient-Centered Research Design for Health Care Innovation

Considerations Regarding Underuse of Approved TBI Diagnostic Devices in Military Environments

Payer Considerations

Discussion

3 PREVENTION

A Lived Experience Perspective

TBI Prevention Strategies in Professional American Football

Automation, Customization, and TBI Trends in Motor Vehicle Crashes

Innovative Approaches to Fall Prevention

Discussion

4 CLINICAL DECISION SUPPORT FROM DATA TO IMPACT

A Lived Experience Perspective

Statistical and Machine Learning Approaches to TBI Prediction

Ultrahigh-Performance MRI in TBI

Multimodal Electrophysiological Biomarkers

Concussion Diagnostics With Eye Tracking

Discussion

5 TREATMENT

A Lived Experience Perspective

Clinical Trial Designs to Accelerate Progress in the Treatment of TBI

Panel on Pharmacological and Nonpharmacological Treatment

Discussion

6 LOOKING TO THE FUTURE

APPENDIXES

A References

B Statement of Task

C Workshop Agenda

D Planning Committee, Speaker, and Moderator Biographies

Figures and Table

FIGURES

2-1 Serum profiles of GFAP and UCH-L1 biomarkers after injury. Arrows indicate the peak serum concentrations of UCH-L1 (red arrow; 8 hours) and GFAP (blue arrow; 20 hours) after injury

4-1 Identification of TBI patient groupings through topological data analysis

4-2 Concussion index values over time in athletes with and without concussion

5-1 Depiction showing potential features of a platform trial design

5-2 Depiction of a multifactorial platform trial

TABLE

5-1 Comparison of the Characteristics of Various Trial Designs

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Acronyms and Abbreviations