Principal Investigator(s)
Investigator(s)
Study Location
Significance of the Problem
Specific Aims and Objectives

Principal Investigator

Joseph Bleiberg, Ph.D. (MedStar/NRH component)
Deborah Warden, M.D. (DVBIC/WRAMC component)

Tresa Roebuck Spencer, Ph.D. (NRH)
Laurie Ryan, Ph.D. (WRAMC)
Karen Schwab, Ph.D. (WRAMC)
Daniel Herr, M.D. (WHC)
Dennis Reeves, Ph.D. (US Navy)

NRH, WHC, WRAMC

Significance of the Problem

One of the central objectives of the presently proposed project is to create a parallel, civilian-focused analog of the above-noted DVBIC projects. Since civilian TBI is predominantly of the acceleration/deceleration type, the civilian group can serve as one of the comparison groups for studying similarities and differences between blast and acceleration/deceleration TBI, with the other comparison groups being DVBIC blast concussion patients and DVBIC "traditional" acceleration/deceleration TBI patients.

There are multiple components needed to accomplish the above objective. First, is DVBIC data on blast and acceleration/deceleration TBI patients. This DVBIC work has been ongoing for many years, is planned to continue into the future, and is sponsored by and funded from sources entirely independent of the present proposal and the MedStar system. Thus, while DVBIC data is central to the present proposal, funding for DVBIC activities and clinical assessment protocols is not part of the present proposal. The present proposal addresses and seeks funding for creation of the following three components. First, is the creation of parallel databases and other structures to facilitate linkages between DVBIC and MedStar data sets and to promote collaborations between investigators from the two separate and independent medical systems. Second, is the creation of NRH/MedStar clinical assessment protocols that "mirror" those of the DVBIC projects. And third, is application of these protocols to data collection using NRH/MedStar TBI patients, thereby creating a civilian TBI data set maximally comparable to the DVBIC data sets.

Creation of the NRH/MedStar civilian-focused "mirror" of the DVBIC project will employ the combined resources of the Level I Trauma Center at the Washington Hospital Center (WHC), the 28-bed inpatient Brain Injury Rehabilitation Program at the National Rehabilitation Hospital (NRH), and the NRH Outpatient Network comprised of over 30 community-based rehabilitation clinics. The Trauma Center at WHC covers a broad geographic region via helicopter evacuation and transport and includes a world-renowned Burn Unit. WHC trauma services are tightly integrated with the inpatient and outpatient rehabilitation services of NRH. As sister hospitals within the Medstar system, WHC and NRH have overlapping medical staffs, research infrastructures, and information and administrative systems.

A byproduct of the presently proposed collaboration is that it will facilitate transfer of DVBIC expertise regarding the special needs of blast patients to civilian trauma centers and hospitals. Events such as the recent terrorist bombing in Spain, with nearly 200 dead but a much larger number of survivors - civilians with blast injuries - underscore the need to incorporate DVBIC knowledge into the disaster plans of America's civilian hospitals.

Specific Aims and Objectives

Aim 1. Identify and assess a civilian TBI sample that matches the DVBIC samples as closely as possible, including demographics, whole-body injury severity, TBI severity, and medical comorbiditites.

Aim 2. Characterize the nature and severity of medical, cognitive, and emotional dysfunction suffered by civilian victims of TBI.

Aim 3. Compare and contrast the DVBIC and NRH/MedStar populations (DVBIC project is already funded and ongoing, and is not part of present funding request; present proposal is for funding creation of the NRH/MedStar component and for development of parallel databases and other structures to facilitate linkage and collaboration between DVBIC and NRH/MedStar).

Aim 4. Compare and contrast blast-related TBI to military and civilian acceleration/deceleration-related TBI, using datasets from the DVBIC and the NRH/MedStar projects.

Aim 5. Incorporate knowledge developed above into recommendations for civilian hospitals' disaster plans.