Site-Specific and Module Studies

Mayo Clinic's Traumatic Brain Injury (TBI) Model System is conducting research to determine the incidence of TBI among Tribal communities in the upper Great Lakes region, understand lived experiences and support needs, and reduce TBI-related health disparities within Native communities.

SITE-SPECIFIC STUDIES

Ways of Knowing: Listening to Great Lakes Tribal Communities To Characterize Traumatic Brain Injury Incidence, Impact, and Health Inequities

Tribal communities in the upper Great Lakes region are at high risk of TBI, and injury estimates are low due to racial misclassification. In this two-part study, Mayo Clinic will partner with the Great Lakes Inter-Tribal Epidemiology Center (GLITEC), state trauma programs and the Indian Health Service (IHS) Bemidji Area Office.

First, investigators at Mayo Clinic will collaborate with GLITEC and state trauma programs in Michigan, Minnesota and Wisconsin to determine the incidence of TBI among Tribal communities from 2012 to 2022. The study is to be done by secure, deidentified linking of state trauma registry and IHS Tribal registry data sets using specialized software to minimize racial misclassification. The anticipated outcome is a more accurate understanding of the characteristics of TBI in Tribal communities.

Second, the goal is to learn about lived experiences and medical, cultural and social support needs following TBI through Gathering of Native American (GONA)-type listening sessions. Participants will include:

• Tribal members with TBI in urban and rural settings.
• Their families.
• Their Tribes.
• Tribal, state and health care policymakers.
• Tribal health care providers.

Anticipated outcomes are identifying what is important about TBI in Tribal communities and establishing a foundation of trust, respect and knowledge on which to build sustainable research relationships. A long-range goal is working in partnership to identify community priorities and potential public health intervention targets, to promote health equity and to reduce disease burden related to TBI.

Recruitment

Mayo Clinic will sponsor three 1.5-day listening events during the study period. Specific locations will be determined by consensus so that rural and urban Tribal communities are equally represented. Study investigators will partner with two respected, trusted and highly skilled facilitators who have been implementing listening sessions in Tribal communities for a long time. Up to 20 participants per state will be invited from all 34 Tribal and three urban health programs in Michigan, Minnesota and Wisconsin. Recruiting for these in-person listening sessions is projected to start in early 2024. Additional information about recruitment will be posted as soon as it becomes available.

MODULE STUDIES

The TBI Model Systems have a unique and longstanding infrastructure for conducting research. To take advantage of this, and to continue to learn about recovery and rehabilitation after TBI, centers often work together to carry out additional research. Below are current collaborative studies underway.

Predicting Outcome After Moderate-Severe TBI Using a CT Head Deep Learning Model

Mayo Clinic is leading a collaborative study during the TBI Model Systems 2022 to 2027 funding cycle. Computerized tomography (CT) of the head is used to evaluate acute TBI. CT results have been found to correlate only with acute outcomes including the need for brain surgery or death, rather than helping to determine long-term prognosis — information that is important to patients and families, and for planning for care beyond hospitalization. Deep learning, a form of artificial intelligence, is capable of encoding imaging features not visible to the naked eye. This study involves partnering with Mayo Clinic's Digital Innovation Lab and other TBI Model System centers to unite clinical information from a projected 8,000 to 10,000 patients with moderate to severe TBI with their digital CT data to inform a deep-learning model of anatomical injury severity.

Mayo Clinic is participating in two additional module studies with other TBI Model System centers during the 2022 to 2027 funding cycle:

• State Programs and Outcomes from TBI.
• Associations of Early Life Adversity and Neighborhood Environment with TBI Outcomes in the TBIMS National Database.

OTHER STUDIES

Comparing Treatment Approaches To Promote Inpatient Rehabilitation Effectiveness for Traumatic Brain Injury (CARE4TBI)

The CARE4TBI study involves 15 TBI Model System centers across the United States. Investigators at Ohio State University and New York University lead the study. Dmitry Esterov, D.O., is the site investigator at Mayo Clinic. CARE4TBI will enroll about 1,600 inpatients with moderate to severe TBI to determine which rehabilitation strategies optimize outcomes over the first year following injury.

ENRICH Brain Health Study — Long-term Trajectories of Cognition and Psychological Health in Civilians and Veterans With Traumatic Brain Injury

The LEveraging Nationwide Research Infrastructure to EnriCH Brain Health after TBI study, known as the ENRICH Brain Health Study, comprises five projects funded by the U.S. Department of Defense. Nineteen existing TBI Model System (TBIMS) centers are participating in ENRICH Project 2, which leverages rich data resources from both civilians and Veterans Affairs Polytrauma Rehabilitation Centers and the related TBIMS National Database. Novel analyses of existing data will characterize transitions across clinical states of function, cognition and mood in the first five years after TBI. Also, new data will be collected to understand risk and resilience factors associated with two areas of highest concern for people living with TBI: cognition and suicide risk.