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Endotypes and the Path to Precision in Moderate and Severe Traumatic Brain Injury

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Abstract

Heterogeneity is recognized as a major barrier in efforts to improve the care and outcomes of patients with traumatic brain injury (TBI). Even within the narrower stratum of moderate and severe TBI, current management approaches do not capture the complexity of this condition characterized by manifold clinical, anatomical, and pathophysiologic features. One approach to heterogeneity may be to resolve undifferentiated TBI populations into endotypes, subclasses that are distinguished by shared biological characteristics. The endotype paradigm has been explored in a range of medical domains, including psychiatry, oncology, immunology, and pulmonology. In intensive care, endotypes are being investigated for syndromes such as sepsis and acute respiratory distress syndrome. This review provides an overview of the endotype paradigm as well as some of its methods and use cases. A conceptual framework is proposed for endotype research in moderate and severe TBI, together with a scientific road map for endotype discovery and validation in this population.

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Authors and Affiliations

  1. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Tej D. Azad, Pavan P. Shah & Robert D. Stevens

  2. Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Robert D. Stevens

  3. Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Robert D. Stevens

  4. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Phipps Suite 455, Baltimore, MD, 21287, USA

    Han B. Kim & Robert D. Stevens

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TDA created the article outline, performed the literature review, and wrote the manuscript. PPS participated in the literature review and drafting of the manuscript. HBK reviewed and edited the manuscript. RDS conceptualized the article and reviewed and edited the manuscript. The final manuscript was approved by all authors.

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Azad, T.D., Shah, P.P., Kim, H.B. et al. Endotypes and the Path to Precision in Moderate and Severe Traumatic Brain Injury. Neurocrit Care 37 (Suppl 2), 259–266 (2022). https://doi.org/10.1007/s12028-022-01475-6

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