- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05688462
Studying Trends of Auto-Regulation in Severe Head Injury in Paediatrics (STARSHIP)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This is an observational prospective cohort study. Children admitted to ten identified PICUs in the UK with severe TBI with a clinical need for ICP and ABP monitoring are being included for data collection. The database will contain routinely monitored physiological parameters during management of PTBI in PICU. Without disturbing the routine care and management of these patients, investigators are collecting this data continuously in a bedside laptop equipped with the study software (ICM+, Cambridge Enterprise Ltd, Cambridge, UK). Alongside these physiological parameters, investigators are also collecting relevant clinical and demographic data (details below) and follow these patients for up to 12 months post ictus to assess neuro-psychological outcome. The created database will be used to analyze the state of cerebral autoregulation. Investigators will also analyze the data to see if investigators can derive optimal cerebral perfusion pressures based on the state of autoregulation and compare it with the patient outcome at 6 and 12 months. The database can also be subsequently used in the future projects testing hypotheses inspired by the experience gained in the adult TBI population research & to answer important questions about severe PTBI.
Inclusion Criteria:
- Patients 16 years old or younger at the time of injury
- Admitted to PICU for management of TBI
- TBI-related pathology confirmed on CT or MRI
- Clinical requirement for invasive monitoring of ICP and ABP
Exclusion Criteria:
- None
Study Aim: The investigators aim to create a research database of high-resolution monitoring data from PTBI patients along with the clinical and demographic details and neuro-psychological outcome up to 12 months post-ictus, from 10 UK PICUs to be used for research purposes. As the first step, investigators analyze the data to determine retrospective optimal clinical parameters when managing these patients. The investigator's hypothesis is that investigators can define the optimal parameters for CPP based on indices of autoregulation (PRx) and that the optimal parameters of CPP and PRx in PTBI will differ to adults, both qualitatively and quantitatively.
Study Objectives:
Primary Objective: To detect thresholds of PRx associated with favourable outcome in PTBI.
Secondary objectives:
- Characterise patterns of optimal CPP in PTBI as a function of age, severity and character of injury, intracranial pressure, etc.
- Compare the fluctuations in these measured parameters with the outcome.
- Establish a comprehensive paediatric database of a basic set of high resolution (pulse waveforms resolution) neuro-monitoring data including ICP, ABP and ECG.
Patient Recruitment and Consent: Each PTBI patient admitted to the recruiting PICU with invasive monitoring of ICP and ABP is considered for recruitment. The research team at each recruiting PICU identifies the patients and sets up high-resolution data collection to the project laptop under an anonymised ID as soon as possible after the patient has been commenced on invasive monitoring and stabilized on PICU. Physiological and clinical data is recorded under this unique study ID. As the acute phase of the project is purely observational and does not involve any therapeutic intervention or change in regular standard care, investigators take a deferred consent for acute data collection and sharing. This is important to obtain a bias-free sample and ensure capture of early changes in intracranial physiology after head injury. When appropriate, the identified guardian/parent is informed and consented for data sharing and follow-up before the patient is discharged from the hospital. For patients who die before the consent can be obtained, the clinician in charge of patient's clinical care only (not study team) will access and anonymise data of the deceased patient under his/her clinical care; this anonymised data will then be provided to the study team.
Data Collection: ICP is monitored with an intraparenchymal microsensor inserted into the right (predominately but can be left) frontal cortex and ABP is monitored in the radial or femoral artery with a zero calibration at the level of the right atrium. The head end elevation is part of the standard international protocol for management for PTBI, and any deviations from this policy in individual cases will be recorded. Full resolution data of routinely monitored physiological parameters in managing PTBI [ICP, ABP, ETCO2, SpO2 and ECG] is collected from bed-side monitors. Pulsatile signals [ICP, ABP and ECG] are recorded with the maximum sampling frequency offered by the bed-side monitors, at least 100 Hz for invasive pressures, and at least 200Hz for ECG. This is done using relevant, monitor type specific, data export protocols implemented in the study (ICM+) software running on a bed-side laptop. The same software will be later used for the retrospective analysis of all stored signals. The continuous data collection is stopped when the patient either starts to wake up or dies and the invasive monitoring is stopped. Apart from general demographics and clinical data, the other data being collected are mechanism and details of injury, relevant past history, post resuscitation Glasgow coma scale, initial pupillary size and reactivity, pre-hospital hypoxia/ hypotension/ hyperthermia/ cardiopulmonary resuscitation, injury & disease severity scores (Pediatric Index of Mortality- PIM II score, Injury Severity Score- ISS), CT scan findings. The investigators are also collecting: daily laboratory values (hemoglobin, glucose, sodium, lactate), PaO2, PaCO2 and FiO2, PEEP, medical interventions for TBI (positioning, collar, temperature, CO2, glucose, hypertonic saline or mannitol, sedation/paralysis, barbiturate coma, anti-seizure medication, use of vasoactive drugs to maintain blood pressure & surgical interventions (haematoma evacuation, elevation of depressed fracture, CSF diversion-external ventricular drainage, new brain imaging, any other relevant event.
Study Type
Enrollment (Estimated)
Contacts and Locations
Study Contact
- Name: Shruti Agrawal, MD
- Phone Number: +441223348066
- Email: shruti.agrawal1@nhs.net
Study Locations
-
-
Cambridgeshire
-
Cambridge, Cambridgeshire, United Kingdom, CB2 0QQ
- Recruiting
- Shruti Agrawal
-
Contact:
- Shruti Agrawal, MD
- Phone Number: 07886500431
- Email: shruti.agrawal1@nhs.net
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Sampling Method
Study Population
Description
Inclusion Criteria:
- Patients 16 years old or younger at the time of injury
- Admitted to PICU for management of TBI
- TBI-related pathology confirmed on CT or MRI
- Clinical requirement for invasive monitoring of ICP and ABP
Exclusion Criteria:
- None
Study Plan
How is the study designed?
Design Details
- Observational Models: Cohort
- Time Perspectives: Prospective
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
To detect thresholds of PRx associated with favourable outcome in PTBI
Time Frame: 12 months
|
12 months
|
Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Characterise patterns of optimal CPP in PTBI as a function of age, severity and character of injury, intracranial pressure
Time Frame: 12 months
|
12 months
|
Compare the fluctuations in these measured parameters with the outcome.
Time Frame: 12 months
|
12 months
|
Establish a comprehensive paediatric database of a basic set of high resolution (pulse waveforms resolution) neuro-monitoring data including ICP, ABP and ECG
Time Frame: 12 months
|
12 months
|
Collaborators and Investigators
Sponsor
Collaborators
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- ADDENBROOKESHPTBI
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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