IGEH Annual Report 2006

Internationale Gesellschaft zur Erforschung von Hirntraumata

International Neurotrauma Research Organzation

IGEH Annual Report 2006

Vienna, Austria

Internationale Gesellschaft zur Erforschung von Hirntraumata

International Neurotrauma Research Organization

Mölkergasse 4/3, A-1080 Wien, Austria

Tel/Fax: +43-1-4090363

Chairman of Scientific Medical Board’s Address

Univ.Prof.Dr.Med. Walter Mauritz, PhD.

The year 2006 was one of INRO’s most successful years so far. We were finally able to submit 6 papers to the publishers of the “Middle European Journal of Medicine”, and all 6 papers were accepted. Thus, for the first time, the situation of TBI patients in Austria has been described in some detail. New questions arose which we will try to answer by analyzing the large set of data we have, including the data from the projects in the Balkan countries as well as Slovakia. We were able to attract some promising new Research Fellows (Valeria Rudel, Marek Majdan and Balasz Zobor) who will assist with data analysis, and Sasha Brazinova has returned to do some research as well as assist Prof. Rusnak with running the daily business of INRO.

INRO is on a good course, and doing research more actively than ever before. I am looking forward to continue working with this exceptional group of researchers.

CONTENTS

  1. IGEH/INRO.. 5
  2. Members. 5
  3. Directors. 5
  4. Medical Advisory Board. 5
  5. Researchers. 6
  6. Donors. 6
  7. The TEAM of INRO.. 7
  8. PUBLICATIONS. 8
  9. List of conferences. 8
  10. List of publications. 10
  11. PROJECT PROPOSALS. 11
  12. Project proposals submitted in the past year 11
  13. Project proposals started in the past year (to be submitted in the 2007) 11
  14. EDUCATION ACTIVITIES. 12
  15. MEETINGS. 13
  16. PLANS for the YEAR 2007. 14

 

1.  IGEH/INRO

a.   Members

DI Gobert Auersperg-Trautson

Dr. Kordula Fleiss

Mrs. Isabelle Harnoncourt

Dr. Wulf-Gordian Hauser

Mrs. Alexandra Hardegg

Mr. Maximilian Hardegg

Mr. Geoffrey Hoguet

Mrs. Annie Laurie Auersperg Isham

Mr. Ralph H. Isham

Dr. Lindi Kalnoki

Mr. Franky Lippitt

Prof. Dr.Med. Walter Mauritz

Mr. Johannes Orsini-Rosenberg

Mr. Peter C. Quinn

Dr. Med. Martin Rusnak

Mrs. Marie-Therese Rutherfurd

Mag. Andreas Treichl

b.   Directors

Mrs. Annie Laurie Auersperg Isham, Honorary Chairperson

Mr. Johannes Orsini Rosenberg, President

Mrs. Daisy Rutherfurd,Vice-president

Mrs. Alexandra Hardegg

Mrs. Isabelle Harnoncourt

Dr.Wulf Gordian Hauser

Mr. Geoffrey Hoguet

Mr. Ralph H. Isham

Dr. Lindi Kalnoky

Mr. Peter C. Quinn

c.   Medical Advisory Board

Prof. Dr. Med. Walter Mauritz, PhD, Chairman

Prof. Toomas Asser, M.D., Ph.D., Prof. of Neurosurgery, Dean of the Univ. of Tartu, Estonia

Prof. Finn Kamper-Jorgensen, M.D., Ph.D., Director, Danish Institute of Public Health, Copenhagen, Denmark

Prof. Ramiro Diez Lobato, Prof. of Neurosurgery, Madrid, Spain

Prof. Walter Mauritz, M.D., Prof. of Anaesthesiology and Intensive Medicine, Chairman of the IGEH Med. Advisory Board, LB Unfallkrankenhaus, Vienna, Austria

Prof. Franco Servadei, Prof. of Neurosurgery, representative of European Brain Injury Consortium to IGEH, Cesena, Italy

Prof. Massimo Sceratti, M.D., Associate Professor of Neurotraumatology, Institute of Neurosurgery, Catholic University, Rome, Italy

Prof. Beverly C Walters, M.D.,M.Sc.,FRCSC, FACS, Chief of Neurosurgery Associate Professor of Clinical Neurosciences, Brown University School of Medicine, Providence, Rhode Island, USA

Prof. Petr Wendsche, M.D., CSc, spinal and trauma surgeon, Trauma Hospital, Brno, Czech Republic

Prof. Daniel West, Jr., Professor of Health Management, University of Scranton, USA

Prof. David Yates, Prof. of Emergency Medicine, Department of Emergency Medicine, Salford, UK

d.    Researchers

Prof. Dr. Med. Martin Rusnak, PhD, Executive Director

Prof. Dr. Med. Walter Mauritz, PhD, Researcher

Dr. Med. Alexandra Brazinova, PhD, Research Fellow

Dr. Marek Majdan, PhD, PhD, Research Fellow

Dr. Med. Johannes Leitgeb, Scholar

Dr. Lucia Lenartova, Research Fellow

Dipl. Ing. Ivan Janciak, IT Manager

Dr. Med. Valeria Rudel, Research Fellow

Balasz Zobor, student

Mag. Ingrid Wilbacher, Research Fellow

Dr. Med. Annalisa Rosso, Research Fellow

e.   Donors

Aventis Pharma Ges.m.b.H.

EBEWE Ges.m.b.H.

NYCOMED AUSTRIA Ges.m.b.H.

PHILIPS Medizinische Systeme Ges.m.b.H.

Sunny van Bülow Trust

  1. The TEAM of INRO

Dr. Martin Rusnak became a Full Professor of Public Health and chairman of the Department of Public Health at the Faculty of Health Care and Social Work, Trnava University, Slovak Republic.

This fact brought more volunteers working with INRO on projects. Students of Trnava University come to INRO office and work on their doctoral thesis, such as effects of transportation time on TBI outcome or dynamic of ICP curve in relation to health outcome.

Prof. Walter Mauritz will be approved as visiting professor at the Trnava University.

Dr. Johannes Leitgeb is a trauma surgeon at the University Clinic for Emergency medicine, AKH-Wien. He cooperates with IGEH for three years now, has been involved in project activities focused mainly on clinical evaluations of brain trauma treatment data.

Dr. Annalisa Rosso has left for a UNDP project in Cairo, but keeps in contact.

Dr. Alexandra Brazinova has returned from US, where she studied in the University of California, School of Public Health the issues of mental health epidemiology. She is back with us, works at various project proposals, namely ICP and Outcome and Quality of Life after TBI, both to be submitted as grant applications in 2007, and she also provides administrative support to the office.

Dr. Lucia Lenartova worked in the General Health Insurance Company in the Slovak Republic and as INRO team member she participates in development of scientific papers and works on her PhD thesis on brain trauma at the Trnava University.

Dr. Marek Majdan comes from Trnava University. He has a PhD in environmental health and Geographic Information Systems. He is analyzing the data from the ITCP database, mainly from the Balkan project. Marek is skilled in “software R”, very powerful statistical tool. This allows using more sophisticated statistical tools for survival analysis.

A new member of the team is Balazs Zobor, a student of business informatics, computer sciences and electrical engineering at the Technical University in Vienna. Balazs is helping the INRO team and working mainly with Dr. Rusnak and Dr. Majdan on the statistical analysis of ITCP data.

Another new member of the tem is Dr. Valeria Rudel, an anaesthesiologist currently at maternity leave. She works with IGEH on cooperation with the Russian Association of Anaesthesiologists and Intensivists and on future project proposals.

  1. PUBLICATIONS
    1. List of conferences with Abstracts published

First Congress of Surgery of Federation of Bosnia and Herzegovina with International Participation, Sarajevo, Bosnia and Herzegovina

Dizdarević K., Rusnak M., Mauritz W., Omerhodžić I., Hasanagić A., Girroto D., Soljakova M., Splavski B., Vukić M., Wilbacher I., Brazinova A., Piribauer F.: Implementation of severe traumatic brain injury guidelines. Abstract book. First Congress of Surgery of Federation of Bosnia and Herzegovina with International Participation, Sarajevo, 12-15 april, 2006

The 8th International Neurotrauma Symposium, Rotterdam, The Netherlands

Mauritz,W., Leitgeb,J., Lenartova,L., Rosso,A., Janciak,I., Wilbacher,I., Rusnak,M. :Severe Traumatic Brain Injury in Austria: Intensive Care Management. The 8th International Neurotrauma Symposium, May 21-25, 2006, Rotterdam, The Netherlands

Rusnak,M., Leitgeb,J., Lenartova,L., Rosso,A., Janciak,I., Wilbacher,I., Mauritz,W.: Guidelines-based management of patients with severe TBI. The 8th International Neurotrauma Symposium, May 21-25, 2006, Rotterdam, The Netherlands

J.Leitgeb, K.Erb, L.Lenartova, I.Janciak, I.Wilbacher, M.Rusnak, W.Mauritz: Severe Traumatic Brain Injury in Austria V: Surgical Management. The 8th International Neurotrauma Symposium, May 21-25, 2006, Rotterdam, The Netherlands

Fourth International Conference on Health Care Systems, Bratislava, Slovakia

  1. Rusnak, W.Mauritz, F.Lecky, M.Kaniansky: Evaluation of TBI guidelines using AGREE. Fourth International Conference on Health Care Systems, Bratislava, July 10-12, 2006

W.Mauritz, M. Rusnak, I.Janciak, J.Leitgeb, K.Erb, L.Lenartova, A.Rosso, I.Wilbacher: How to monitor health effects of TBI guidelines implementation in clinical practice. Fourth International Conference on Health Care Systems, Bratislava, July 10-12, 2006

  1. Lenartova , M. Rusnak, L. Pasztor , J. Holoman, P. Kristufek: National institute of quality and innovations – NIKI. Fourth International Conference on Health Care Systems, Bratislava, July 10-12, 2006
  1. Lenartova, M. Rusnak, V. Rusnakova, E. Heijdelberg, J. Koot: Project MATRA: Building quality development program in Slovakia. Fourth International Conference on Health Care Systems, Bratislava, July 10-12, 2006
  1. Rusnakova, L. Lenartova, J. Koot, M. Rusnak: Performance indicators for hospitals – results of the PATH WHO-MATRA project. Fourth International Conference on Health Care Systems, Bratislava, July 10-12, 2006

XXIX.days of Medical Biophysics, Bratislava, Slovakia

Rusnáková,V., Rusnák, M., Bachárová,L.: Manažement kvality a vzdelávanie v zdravotníckej informatike. (invited lecture)

XXIX.dni lekárskej biofyziky, Bratislava, 16.-18.mája, 2006

TARN Conference 2006, London, UK

Martin Rusnak: KZ Monitoring TBI guidelines adherence and effects on health and performance outcomes. TARN Conference 2006. The Audit & Research Trauma Care governance, performance and new directions, London, November 2006 (invited lecture)

    1. List of publications (published early 2007)

Rusnak M, Janciak I, Majdan M, Wilbacher I, Mauritz W.: Severe Traumatic BrainInjury in Austria I: Introduction to the study. Wien Klin Wochenschr. 2007Feb;119(1-2):23-28. Rosso A, Brazinova A, Janciak I, Wilbacher I, Rusnak M, Mauritz W.: Severe TraumaticBrain Injury in Austria II: Epidemiology of hospital admissions. Wien KlinWochenschr. 2007 Feb;119(1-2):29-34. Lenartova L, Janciak I, Wilbacher I, Rusnak M, Mauritz W.: Severe Traumatic BrainInjury in Austria III: Prehospital status and treatment. Wien Klin Wochenschr. 2007Feb;119(1-2):35-45. Mauritz W, Janciak I, Wilbacher I, Rusnak M.: Severe Traumatic Brain Injury inAustria IV: Intensive care management. Wien Klin Wochenschr. 2007Feb;119(1-2):46-55. Leitgeb J, Erb K, Mauritz W, Janciak I, Wilbacher I, Rusnak M. : Severe TraumaticBrain Injury in Austria V: CT findings and surgical management. Wien KlinWochenschr. 2007 Feb;119(1-2):56-63. Rusnak M, Janciak I, Majdan M, Wilbacher I, Mauritz W. :Severe Traumatic BrainInjury in Austria VI: Effects of guideline-based management. Wien Klin Wochenschr.2007 Feb;119(1-2):64-71.

 

4.  PROJECT PROPOSALS

a.     National project proposals submitted 2006

  1. Mauritz & I. Wilbacher: Quality of Nursing and Health Outcomes in Brain Trauma Management,

submitted to the Austrian National Bank’ Jubileumsfund (rejected)

b.     National project proposals started in 2006 (to be submitted in 2007)

Johannes Leitgeb – „Beziehung zwischen CT Befund und Behandlungsergebnis von Patienten mit schwerem Schädel-Hirn-Trauma“ Entwicklung eines Scores zur  Klassifizierung von CT-Befunden  bei  Patienten mit schwerem Schädel-Hirn-Trauma

submitted to the Fund of the Mayor of Vienna January 2007

 

Walter Mauritz, Martin Rusnak, Alexandra Brazinova – ICP changes after TBI and relation to outcome

submitted to FWF (Wissenschaftsfonds) March 2007

Alexandra Brazinova – Quality of Life in Patients after TBI,

to be submitted to the Austrian National Bank’ Jubileumsfund by June 2007

c.      Internationalational project proposals to be submitted in 2007

Application for COST funding – application deadline 3/31/2007(www.cost.esf.org <http://www.cost.esf.org/>  )

The project proposes to establish an international network collaboration that will permit characterization of differences in trauma organization, treatment approaches and ethical requirements for research across participating countries, facilitating identification of areas for improvement and better targeting of prevention campaigns. The proposed network, initiated by the European Brain Injury Consortium (EBIC) and the International Neurotrauma Research Organization (INRO/IGEH), will include most EU member states, the Russian Federation and the People’s Republic of China (25-30 countries altogether). The main objective is to improve head injury care by multidisciplinary, multinational network collaboration and will form a first step towards international harmonization of trauma organization and treatment for head injury.

Framework Programme 7

http://cordis.europa.eu/fp7/home_en.html

The global aim is to develop and validate an improved methodology for standardized data collection on hospital admissions for severe and moderate head injury (including polytrauma) across EU member states. Data collection will address both acute and post-acute care phase as well as long term outcome (including disability), utilizing up to date information technology.Specific tools will be developed and validated to assess quality of provided care across the treatment chain (performance indicators) and to better compare treatment results between countries/centers. These tools will include novel approaches for classification of head injury (based on prognostic models) and for calculating disease specific standardized mortality ratios. Standardized outcome assessment will not only focus on assessments by health care professionals, but also on self assessment with a disease specific quality of life scale.

5.  EDUCATIONAL ACTIVITIES

INRO signed an agreement with the University of Scranton in the US. Prof. Rusnak was asked to serve as a consultant in a PhD study for the Professor Assistant Stephan Szydlowski, who is going to defend his thesis on Economical Consequences of TBI in US and Europe.

Prof. Rusnak resumed a position of the Chair of Department of Public Health in the Faculty of Health Services and Social Work in Trnava University. He continues to supervise PhD studies of 2 INRO members on the topic of TBI.

Prof. Mauritz was asked to become a visiting professor in Faculty of Health Services and Social Work in Trnava University.

Prof. Rusnak was offered a membership at the Euroacademia Multidisciplinaria Neurotraumologica.

 

6.  MEETINGS

As in the previous years, weekly meetings were held in the INRO premises on Tuesdays. The project team has discussed progress of the planned activities and new ideas and plans.

Guest Lectures at the INRO office in 2006:

  1. Piribauer: differenced between departments that may influence outcomes after TBI.

Apart from the regular meetings, the team members participated in the following INRO-related events:

21 -25 May 2006 – 8th International Neurotrauma Symposium Rotterdam, The Netherlands, 3 posters presented. Participants: J. Leitgeb, M. Rusnak, W. Mauritz

October 2006 – meeting with the EU Directorate of Health and Consumer Protection DG SANCO director Dr. Andrzej Rys, to initiate better cooperation with EU. The next step is to develop a framework of projects, which will allow INRO to cooperate broadly across the Europe on the TBI topic. INRO is planning to prepare a project for FP7 (EU Framework Program for Research) and to COST (Cooperation in Science and Technology). Participants: M. Rusnak, W. Mauritz

September 2006 – Keynote Lecture at the Austrian Anaesthesia and Intensive Care Symposium in Linz, Austria – “Guidelines for treatment of patients with severe TBI in Austria”. Participants: W. Mauritz

 

7.  PLANS for the YEAR 2007

Work plan

Develop and submit project proposals (see #4)

Analyze and publish data from the “Austrian Standardized Dataset for Intensive Care (ASDI). ASDI collects data from 43 Austrian ICUs; it has now more than 80.000 patients from the years 2000 – 2006 in the database. We plan to analyze the subset of patients with TBI (approx. 4000 data sets), and to compare outcomes for patients with GCS < 9 who had ICP monitoring to those who did not have ICP monitoring. With this large set of data it should be possible to elucidate whether ICP monitoring influences outcomes – something which is still not fully clear. This study is funded by the AUVA (Allgemeine Unfallversicherungsanstalt). A paper should be ready for submission to an international journal by fall 2007.

Analyze and publish data from the ITCP database (1200 patients from Austria, Balkan states, and Slovakia). Analysis of the European data set is already under way; at least 2 papers (epidemiology of TBI; effects of introducing guidelines) should be ready for submission to international journals by fall 2007. Further papers on specific aspects of treatment (decompressive vs. osteoplastic surgery, prehospital intubation, etc) are prepared.

Analyze and data from a pilot project (65 patients) where the course of ICP and other variables (CPP, glucose, hyperventilation, etc) was reconstructed as closely of possible. Over the course of the first 10 treatment days hourly values for these variables have been transferred to a database (sets of up to 240 values for each parameter and patient!). The course of ICP (and possibly other parameters) might be related to the short- and long-term outcome of the patients. This project has been funded (in part) by the AUVA (see above).

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