The Approaches and Decisions for Acute Pediatric TBI (ADAPT) Trial has enrolled its 700th subject! This comparative effectiveness study, which is led by Safar Center Associtate Director Dr. Michael Bell of the Department of Critical Care Medicine and Dr. Stephen Wisniewski of the Department of Epidemiology, is the largest study of children with severe traumatic brain injury and intends to develop at least 12 new evidenced-based guidelines related to first-line intracranial hypertension therapies, secondary injury detection/treatments and metabolic support. The ADAPT Trial is funded by the National Institute of Neurological Disorders and Stroke (NINDS). Several NINDS ancillary studies have been initiated – including determining the role of TBI on the body’s microbiome, understanding the role of vasopressors on cerebral autoregulation and identifying unique MRI-based biomarkers. Forty-eight clinical centers in 8 countries are contributing subjects to this study and the full cohort (1000 children) is expected to be recruited by the end of this summer. As follow-up assessments are ongoing, the investigators are preparing an application to enroll an additional cohort of subjects to more fully understand the utility of second-tier intracranial hypertension therapies and how the effectiveness of therapies differs within important sub-populations of children with severe TBI.