Endotypes and the Path to Precision in Moderate and Severe Traumatic Brain Injury

Heterogeneity is recognized as a major barrier in efforts to improve the care and outcomes of patients with traumatic brain injury (TBI). Even within the narrower stratum of moderate and severe TBI, current management approaches do not capture the complexity of this condition characterized by manifo...

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Published inNeurocritical care Vol. 37; no. Suppl 2; pp. 259 - 266
Main Authors Azad, Tej D., Shah, Pavan P., Kim, Han B., Stevens, Robert D.
Format Journal Article
LanguageEnglish
Published New York Springer US 01.08.2022
Springer Nature B.V
Subjects
Asthma
Big Data in Neurocritical Care
Biomarkers
Brain research
Clinical trials
Critical Care Medicine
Cytokines
Disease
Gene expression
Genotype & phenotype
Hypothermia
Inflammation
Intensive
Intensive care
Internal Medicine
Intracranial pressure
Medical prognosis
Medical research
Medicine
Medicine & Public Health
Neurology
Neurosurgery
Pathophysiology
Patients
Precision medicine
Recovery (Medical)
Sepsis
Traumatic brain injury
United States > US
Enrichment
Phenotype
Traumatic brain injury
Precision medicine
Machine learning
Endotype
Heterogeneity of treatment effect
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Summary:Heterogeneity is recognized as a major barrier in efforts to improve the care and outcomes of patients with traumatic brain injury (TBI). Even within the narrower stratum of moderate and severe TBI, current management approaches do not capture the complexity of this condition characterized by manifold clinical, anatomical, and pathophysiologic features. One approach to heterogeneity may be to resolve undifferentiated TBI populations into endotypes, subclasses that are distinguished by shared biological characteristics. The endotype paradigm has been explored in a range of medical domains, including psychiatry, oncology, immunology, and pulmonology. In intensive care, endotypes are being investigated for syndromes such as sepsis and acute respiratory distress syndrome. This review provides an overview of the endotype paradigm as well as some of its methods and use cases. A conceptual framework is proposed for endotype research in moderate and severe TBI, together with a scientific road map for endotype discovery and validation in this population.
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ISSN:1541-6933
1556-0961
DOI:10.1007/s12028-022-01475-6