By Ms. Crystal Maynard (Army Medicine)January 26, 2018
Coming directly from the side of Pittsburgh Steelers linebacker Ryan Shazier, Dr. David O. Okonkwo arrived at Fort Detrick to deliver a lecture on traumatic brain injuries to a full auditorium on Jan. 12.
The highly anticipated lecture, originally slated for December, had been rescheduled as Okonkwo evaluated and performed spine surgery on Shazier who took a rough hit during a game with the Cincinnati Bengals on Dec. 4. Okonkwo, a brain and spinal cord injury specialist, is not only the professor and executive vice chair of neurosurgery at the University of Pittsburgh Medical Center, but he is also a Pittsburgh Steelers team physician.
"Hosting a presenter with this kind of background," said Col. Michael Davis, the host and director of the Combat Casualty Care Research Program, during his opening remarks about Okonkwo, "shows just how important the subject of TBI is to both the military medical community and the country at-large."
Traumatic brain injuries are not just sustained by athletes playing sports. TBI are a significant health issue that is of great importance to the military. TBI are generally characterized in severity by mild, moderate, severe or penetrating, and those at the highest risk of experiencing one are young men performing military duties, according to the Defense and Veterans Brain Injury Center. This makes the military's research into the understanding, prevention and treatment of TBI so important.
The U.S. Army Medical Research and Materiel Command CCCRP seeks to drive medical innovation through development of knowledge and materiel solutions for the acute and early management of combat-related trauma; including point-of-injury, en route and facility-based care, and TBI is one of the program's portfolios of research. The U.S. Department of Defense estimates that 361,092 brain injuries have been sustained by members of the U.S. military, worldwide, since 2000.
Okonkwo kicked off his lecture Towards Precision Medicine in Traumatic Brain Injury: Research Priorities for the Next Decade and delved right in with a look back at how modern medicine has arrived at this point in research and understanding of traumatic brain injuries.
The real successes in TBI research and treatment started in 2000.
"The modern management of traumatic brain injury, in very particularly the comatose patient, was defined in Richmond, Virginia, and Glasgow, Scotland, in the 1970s," said Okonkwo, "and the things that we do in the ICU today are exactly the same with very few exceptions. But since 2000, a series of events occurred that have fundamentally changed the TBI game."
For his lecture, Okonkwo focused on the Department of Defense-supported and directed TBI Endpoints Development Initiative. Better designed clinical trials leading to the first successful treatments for traumatic brain injury are the goals of the TED Initiative. Awarded in 2014, the TED Initiative is supported by a $17 million, five-year grant from the DOD. Funded in direct collaboration with the U.S. Food and Drug Administration, the TED team consists of leading academic clinician-scientists, along with innovative industry leaders in biotechnology and imaging technology, patient advocacy organizations and philanthropies. This unique public-private partnership will examine data from thousands of athletes, Soldiers and the broader civilian population to identify and validate effective measures, or "endpoints," of brain injury and recovery.
Okonkwo cited a comparison of two patients arriving at the hospital. First, there is a cardiac patient that will have a host of rapid diagnostic and triage options available, while the other patient, a Soldier, was injured in training complaining of headaches, dizziness and nausea after hitting his head. Is this Soldier okay and how do we find out?
"In November of 2017, in Pittsburgh, we went to an emergency room and did a finger prick on a patient after a trauma to measure a biomarker, and we were able to predict what that person's CAT scan was going to look like on the basis of that finger prick," said Okonkwo. "This is where the last 17 years have brought us, and this is going to be just the first of victories that are going to start stacking up through the years."
Okonkwo went on to discuss the future of TBI diagnostics, "What we want to be able to do with that Soldier that had an injury is to prick his finger, place the blood on to a chip and load that into a handheld device and be able to figure out if his biomarkers are normal and he can return to his duty station or if he should be sent for further testing."
This is the vision forward for Okonkwo and the TED Initiative.
Okonkwo cited some alarming facts about TBI. In the U.S., every hour, six people die, 31 people are hospitalized, almost 200 people go to the emergency room and 457 people sustain a concussion.
"We know that this is a signature problem for our fighting forces, and it is no longer a silent epidemic like it was for decades. It is in fact one of the fastest growing military and public health problems, and when you look at the statistics, it is remarkable that this problem keeps rising," shared Okonkwo. "So the question becomes how are we doing delivering tools and treatments?"
Awarded to the University of California San Francisco in 2014, the TED team is leveraging its DOD, National Institutes of Health, philanthropic and industry-funded research networks and infrastructure to achieve the research objectives. In addition, the TED Initiative brings together several TBI study datasets containing thousands of TBI subjects, in order to harmonize and curate data into a large metadata set with the goal of identifying candidate clinical outcome assessments and biomarkers.
"With these consortiums and TBI repositories, we are now headed in the right direction, and the TBI team is already using this information to move forward," said Okonkwo.