An Addenbrooke’s doctor has led the UK’s first multi-centre study of its kind aimed at improving outcomes for children with traumatic brain injuries.
Among those who took part was courageous teenager, Mia Jack pictured above with her family and whose story appears at the foot of this article. Mia hopes it will inspire others in the same position.
Initial findings from the study are significant and they have today been published in the international medical research journal, eClinicalMedicine (opens in a new tab), today.
Traumatic brain injury is the leading cause of death and disability in children worldwide and more than two thirds of the survivors suffer longer term problems.
The most severely injured are managed by monitoring blood and brain pressure to set treatment targets and there is potential to improve outcomes by individualising targets by real-time analysis of routinely collected data.
In medical circles this is called “continuous assessment of cerebrovascular autoregulation (CA) using pressure reactivity index (PRx)”. However, experience with cerebrovascular autoregulation monitoring in paediatric traumatic brain injury is limited to single-centre studies, or looking back at past events, suggesting the data may be “inadequate”.
The new study was conducted across ten UK Paediatric Intensive Care Units (PICUs) over five years and focused on 135 children under 16-years and a multitude of factors associated with favourable outcomes, unfavourable outcomes and deaths. The aim was to identify critical thresholds of PRx in relation to outcome and create a research database.
Called STARSHIP (Status of Cerebrovascular AutoRegulation relates to outcome in Severe Paediatric Head Injury), the study findings support PRx monitoring in paediatric traumatic brain injury which could be used to fine-tune treatment targets with the potential of improving outcomes in this vulnerable group of patients. The improved data resource will ultimately be opened to third-party investigators, fostering continued research and collaboration to help improve understanding and outcome from paediatric traumatic brain injury.
Dr Shruti Agrawal, a paediatric intensivist and paediatric trauma lead at Cambridge University Hospitals, who led the study said:
Understanding the underpinning principles and management of raised intracranial pressure and brain perfusion is essential for reducing the morbidity and mortality of traumatic brain injuries.
Our study has many strengths, the most important being the prospective multicentre design with a predefined sample size and protocol. Given the paucity of such evidence and data, STARSHIP database offers a unique opportunity of ongoing research and data collection.
We are indebted to all the patients and their families for participation in this study, to the staff in the PICUs for their contribution, all those affiliated to this work, and our funders, sponsors and supporters.
Dr Shruti Agrawal
Helping were departments within the University of Cambridge; Cambridge and Peterborough NHS Foundation Trust; Birmingham Children’s Hospital; Great Ormond Street Hospital; Leeds Children’s Hospital; Manchester Children’s Hospital; Nottingham Children’s Hospital; Oxford University Hospitals; Royal London Hospital; Sheffield Children’s Hospital and Southampton Children’s Hospital.
It was funded by Action Medical Research for Children (opens in a new tab) and Addenbrooke’s Charitable Trust (opens in a new tab) (ACT), sponsored by Cambridge University Hospitals NHS Foundation Trust, and supported by the National Institute of Health Research (NIHR) Cambridge Biomedical Research Centre and the NIHR Clinical Research Network.
ACT chief executive officer, Shelly Thake, said:
We were delighted to be able to help fund this important study, which was only possible thanks to the generosity of our incredible supporters, some of whom will unfortunately have direct experience of the challenges associated with traumatic brain injury in children.
Shelly Thake
Dr Caroline Johnston, senior research manager, Action Medical Research, added:
Funding research to further our understanding of traumatic brain injury and the long-term consequences is important and brings hope to children and their families. We are delighted to have partnered with Addenbrooke's Charitable Trust to work towards improving the understanding and treatment of severe traumatic brain injuries in children.
Dr Caroline Johnston
The study comes as Cambridge University Hospitals NHS Foundation Trust presses ahead to build a dedicated children’s hospital for the eastern region, combining physical and mental healthcare under one roof. Learn more about it here (opens in a new tab)
Mia’s story – how she survived traumatic brain injury
A courageous teenager who suffered a traumatic brain injury following an horrific accident has spoken about her six years in recovery.
Mia Jack, 18, who was one of 135 children who joined the STARSHIP study published today, applauded the research and those helping her.
The study, led by Addenbrooke’s Hospital, was conducted across ten UK Paediatric Intensive Care Units (PICUs) over five years and focused on a multitude of factors associated with favourable and unfavourable outcomes with the aim of improving treatments.
Mia, from Soham, said:
Anything that helps with traumatic brain injury in children – and raises awareness of it at the same time – has got to be a good thing.
Mia Jack
Mia was thrown over the handlebars of a quadbike during a family activity day when she was just 12. She was glancing back at others when she lost control, and hit a tree headfirst.
She was put into an induced coma at the scene before being airlifted to Addenbrooke’s. Part of her skull was removed to relieve pressure on her brain in an operation called a craniectomy, but immediately after she needed more surgery to remove a blood clot.
For her family it was an agonising wait but music-loving Mia, who lives in with sister Isabella Jack,19, mum Angela Paine and her partner Stuart Jack, woke up when she heard a ukulele being played on the ward.
To Angela’s dismay Mia didn’t recognise her, and could not walk or talk. But over several difficult weeks, Mia’s determination along with the help of specialists, meant she was finally well enough for the next stage.
After a brief rest at home, she went to The Children’s Trust in Surrey - a charity -which offered a two-month rehabilitation programme involving physiotherapy, speech and language therapy, occupational therapy and hydrotherapy.
As she further recovered, Mia began to explore her creative side and particularly enjoyed playing the piano in the common room, to the delight of other children and staff.
A highlight came when she and other young singers helped West End legend and charity ambassador Elaine Paige record a version of ‘Sing a Rainbow’, which was covered by local TV and radio.
Mia returned to Addenbrooke’s to have a titanium plate fitted over the hole in her skull, during which she says David Guetta’s hit ‘Titanium’ became something of a “personal anthem” - and part of her piano playing repertoire.
Cambridge Centre for Paediatric Neuropsychological Rehabilitation offered Mia support over three months, including counselling. It helped her overcome the inevitable low moments, which was also helpful to the family.
The teenager was relieved to return to school and successfully moved up to Cambridge Regional College where she is in her second year of a hairdressing course.
She continues to sing, play the piano, and loves dancing, gymnastics and acting. She hopes to undertake a performing arts course next year, and has discovered a talent for poetry.
Mia’s mum, Angela, who works in catering but is also studying hairdressing, said:
To me Mia’s recovery has been nothing less than a miracle. She is so courageous, so talented, and I am very proud of all she achieves
Angela Paine
Mia, who still struggles to find the odd word and gets easily tired, added:
When I woke after the accident I was completely confused and didn’t know who mum was, what had happened, and I didn’t understand what was going on.
I was wearing a helmet at the time, but apparently my brain was like a jelly in a box that had been really badly shaken, and I was going to be in hospital for some time.
To say it was all a bit of a struggle would be an understatement, but I am a fighter and hope someone else can take inspiration from that
Mia Jack