Sumidtra Prathep, MD
Nominated From: University of Washington
Research Site: Songkla, Thailand
Research Area: Injuries – Tramatic Brain Injury
Primary Mentor: Monica Vavilala, MD (University of Washington)
Adherence to Guidelines of Traumatic Brain Injury (TBI) and Outcomes in Thailand
Injury is the second leading cause of morbidity and mortality in Thailand following cancer. To improve outcomes after TBI, evidence based TBI guidelines for the Acute Medical Management of severe TBI were published in 2007. However, studies suggest that hospital adoption and low adherence may be due to barriers such as lack of conclusive recommendations, lack of guideline knowledge, and lack of procedures to implement guidelines. This is problematic because lack of adherence to these guidelines likely results in high prevalence of secondary insults such as hypoxia and hypotension that are known to adversely affect patient outcomes after TBI. Preliminary data show that the lack of adoption of guidelines for TBI and the high prevalence of secondary insults after hospital admission in U.S. Preliminary data from Songklanagarind hospital, Thailand, show that the prevalence of secondary insults such as hypotension, hypoxia and hypocarbia are high (Preliminary data). Songklanarind hospital is an 816-bed university hospital (25 trauma beds, 10 ICU beds, and 25 neurosurgery beds) in southern of Thailand with a Trauma Registry of 500 trauma patients admitted annually; 600 of which have TBI. Our project goal is to examine the prevalence of and temporal profile of in-hospital post TBI secondary insults (e.g. hypotension, hypoxia, and hypocarbia) and outcome and examine the relationship between adherence to the 2007 Brain Trauma Foundation Guidelines and outcomes. The guiding hypothesis is that adherence predicts outcomes.
Specific Aim #1: To develop an adherence scorecard that quantifies adherence to evidence based TBI guidelines and examine the prevalence and temporal profile of selected in-hospital secondary insults after TBI in Songklanagarind Hospital, Thailand.
Specific Aim #2: To use the adherence scorecard to determine the relationship between adherence to evidence base TBI guidelines and patient outcomes.
- Traumatic Brain Injury (TBI) is a significant Thai public health problem. Worldwide, TBI is the leading cause of trauma related death. Preventing poor outcomes after TBI is not only a national priority in Thailand but also a global priority. It is projected that because of road traffic accidents, Thailand will suffer 40,000 deaths annually since 2007.
- Improving TBI care and outcomes after TBI is needed in Thailand. Data showed that despite publication of evidence based guidelines, large variability in trauma care and outcomes persists. The TBI care pathway is one approach to increasing adherence and decreasing poor outcomes.
This proposal has significance because TBI is a major public health problem. This project is feasible and will benefit patients in Thailand as well. It is innovative because it will result in unique deliverables that can drive TBI care behavior. This study will have impact because it: 1) Addresses the critical gap between guidelines and clinical practice, 2) Explores and improves TBI care processes, 3) Serves as a foundation to conduct joint future clinical trials in TBI, and 4) Considers study feasibility and TBI research needs of Thailand.
Advice for Potential Applicants
When I first began my research, I felt as though I had no idea how to start or what to do. Mentorship, however, led me in the right direction. If you are interested in the area of Global Health research, Fogarty Fellowship will provide the necessary research training under the supervision of mentors within the program and will help you to begin building your own research career.
- Monica S. Vavilala, MD and Joseph Zunt, MD, MPH (US Mentors)
- Nakornchai Phuenpathom, MD and Hutcha Sriplung, MD (Thai Mentors)