Traumatic brain injury (TBI) is recognized as the leading cause of death and disability in all parts of the world and costs the international economy approximately US$400 billion annually, which, given an estimated standardized gross world product of US $73.7 trillion, is a striking 0.5% of the entire annual global output. To address the profound issues related to a drastic increase in emergency department visits and hospitalizations for TBI over the past decades, the United States Congress highlighted injury surveillance as a federal priority. The Centers for Disease Control and Prevention defines surveillance as ?use of health-related data that precede diagnosis and signal a sufficient probability of a case or an outbreak to warrant further public health response?. To prevent TBI, it is essential to understand its distribution and patterns, in addition to having strong knowledge of clinical disorders, characteristic, or other definable entity, that differentiates TBI from other clinical populations. A critical barrier to the progress of the NIH-funded program ?Comorbidity in traumatic brain injury and risk of all-cause mortality, functional and financial burden: a decade-long population based cohort study? was the presence of complex and multifaceted comorbidities in a patient with TBI before and at the time of the injury, and their links to patients? frailty, injury circumstances, severity, and outcomes. This resulted in a shift in the research paradigm, and development of a novel data mining approach used in genomics to sequence more than 70,000 clinical diagnosis codes in a TBI population, and compare them to a matched population. The developed data mining approach allowed not only the validation of previously known risk factors of TBI, but also the identification of associations previously unknown, without any preconceived human biases. This project will continue advancement of a non-hypothesis driven scientific approach, which will: (1) Characterize patients with TBI at three different time periods in relation to the TBI event ? before, at the time of, and after the injury; (2) Develop individual and population level models to study the transitions between the different time states; and (3) Construct and validate predictive models of susceptibility to TBI events, adverse outcomes, and high healthcare resource use at the individual and population level. Decades- long population-based health administrative data from the publicly-funded healthcare system in Ontario, Canada is ready to be further analysed for clinical and technological advancement, to support human thinking in categorizing personal, clinical, and environmental exposure data preceding TBI.

Public Health Relevance

To detect, manage, and prevent traumatic brain injury (TBI), a complex and often lifelong disabling injury, it is essential to understand its distribution and patterns and have a comprehensive knowledge of the clinical disorder, characteristic, or other definable entity that differentiates between and within persons at risk of TBI of varying mechanisms, injury presentation, and its course. This research proposal expands an ongoing NIH-funded project that started to categorize clinical comorbidities and personal and environmental exposure data into clinically meaningful factors that increase the risk of injury and its severity at the population and individual levels. With the support of data mining and big data, this proposed program will advance research methods with a goal-directed learning process and the fields of injury surveillance and precision medicine, covering a variety of interests in public health, brain injury medicine, and behavioural and social sciences.

National Institute of Health (NIH)
National Institute of Neurological Disorders and Stroke (NINDS)
Research Project (R01)
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Neurological, Aging and Musculoskeletal Epidemiology (NAME)
Program Officer
Bellgowan, Patrick S F
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University of Toronto
Zip Code
M5 1S8