{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:25:16Z","timestamp":1789431916503,"version":"build-2803163510"},"reference-count":29,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2025,12,25]],"date-time":"2025-12-25T00:00:00Z","timestamp":1766620800000},"content-version":"unspecified","delay-in-days":24,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["PJT 149019"],"award-info":[{"award-number":["PJT 149019"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["PJT 159488"],"award-info":[{"award-number":["PJT 159488"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,12,10]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Venous thromboembolism (VTE) is a common complication of traumatic brain injury (TBI) and is associated with increased morbidity and mortality. Low molecular weight heparin (LMWH) is recommended for prophylaxis against VTE after trauma but may increase the risk of progression of intracranial bleeding. Limited evidence exists to guide clinicians regarding the optimal timing of VTE prophylaxis in patients with acute TBI. This randomised controlled trial (RCT) will directly compare the safety and effectiveness of early versus delayed initiation of LMWH in patients with moderate to severe TBI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>The study design is a Bayesian adaptive RCT comparing early (within three calendar days of injury) versus delayed (after study Day 7) VTE prophylaxis with the LMWH, dalteparin. All patients receive sequential compression devices until study Day 8. The co-primary effectiveness outcome is the development of clinically important VTE at study Day 8. The co-primary safety outcome is the development of clinically important intracranial bleeding at study Day 8. Secondary outcomes are mortality and functional outcomes (Glasgow Outcome Scale Extended and EQ-5D) measured at study Days 30 and 180; clinically diagnosed VTE to Day 30 and progression of intracranial bleeding to Day 8.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study has been approved through Clinical Trials Ontario\u2019s streamlined ethics review process (board of record, Sunnybrook Health Sciences Centre) and all participating centres. It is conducted in accordance with the Declaration of Helsinki, Good Clinical Practice guidelines and Health Canada regulatory requirements. We anticipate that the trial will achieve wide dissemination through publication in a peer-reviewed medical journal and presentation at international conferences targeting the fields of critical care, trauma and neurosurgery. The results of this trial will help guide clinicians aiming to balance the risks and benefits of early anticoagulant prophylaxis after TBI and will inform guideline development.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT03559114\">NCT03559114<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-114158","type":"journal-article","created":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T05:10:23Z","timestamp":1766725823000},"page":"e114158","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Prophylaxis for venous thromboembolism in traumatic brain injury: protocol for a randomised controlled trial"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct03559114","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Farhad","family":"Pirouzmand","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada"},{"name":"Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francois","family":"Mathieu","sequence":"additional","affiliation":[{"name":"Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada"},{"name":"Division of Neurosurgery, Department of Surgery, Unity Health Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7442-7539","authenticated-orcid":false,"given":"Alireza","family":"Mansouri","sequence":"additional","affiliation":[{"name":"Neurosurgery, Penn State Cancer Institute, Hershey, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanthi","family":"Kavikondala","sequence":"additional","affiliation":[{"name":"The Centre for Clinical Trial Support, Sunnybrook Research Institute, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Alkins","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, Queen\u2019s University, Kingston, Ontario, Canada"},{"name":"Neurosurgery, Kingston Health Sciences Centre, Kingston, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J Gordon","family":"Boyd","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Queen\u2019s University, Kingston, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Christie","sequence":"additional","affiliation":[{"name":"Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Couillard","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada"},{"name":"UCalgary Cumming School of Medicine, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D","family":"Cusimano","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, Unity Health Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul T","family":"Engels","sequence":"additional","affiliation":[{"name":"Surgery, McMaster University, Hamilton, Ontario, Canada"},{"name":"Department of Critical Care, Hamilton Health Sciences, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shane","family":"English","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada"},{"name":"Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada"},{"name":"School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daryl","family":"Fourney","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Fowler","sequence":"additional","affiliation":[{"name":"Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada"},{"name":"Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Geerts","sequence":"additional","affiliation":[{"name":"Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"},{"name":"Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A","family":"Gooderham","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada"},{"name":"Division of Neurosurgery, Department of Surgery, The University of British Columbia - Vancouver Campus, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald","family":"Griesdale","sequence":"additional","affiliation":[{"name":"Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute Clinical Research Unit, Vancouver, British Columbia, Canada"},{"name":"Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia - Vancouver Campus, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Hunter","sequence":"additional","affiliation":[{"name":"Neurology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pejman","family":"Jabehdar Maralani","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E","family":"Kelly","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gail","family":"Klein","sequence":"additional","affiliation":[{"name":"Centre for Clinical Trial Support, Sunnybrook Research Institute, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas H","family":"Kramer","sequence":"additional","affiliation":[{"name":"Departments of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada"},{"name":"Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Kromm","sequence":"additional","affiliation":[{"name":"Departments of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada"},{"name":"Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Demetrios J","family":"Kutsogiannis","sequence":"additional","affiliation":[{"name":"Critical Care Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francois","family":"Lauzier","sequence":"additional","affiliation":[{"name":"Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Centre Hospitalier Universitaire de Qu\u00e9bec-Universit\u00e9 Laval, Qu\u00e9bec City, Quebec, Canada"},{"name":"Department of Medicine and Department of Anesthesiology & Critical Care, Universit\u00e9 Laval, Qu\u00e9bec City, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matylda","family":"Machnowska","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M","family":"Maslove","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Queen\u2019s University, Kingston, Ontario, Canada"},{"name":"Critical Care Medicine, Kingston Health Sciences Centre, Kingston, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Mejia-Mantilla","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Valle del Lili, Cali, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajiv","family":"Midha","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basant","family":"Misra","sequence":"additional","affiliation":[{"name":"Department of Surgery, P D Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurel","family":"Murphy","sequence":"additional","affiliation":[{"name":"Critical Care, Dalhousie University, Halifax, Nova Scotia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C J","family":"O\u2019Kelly","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chirag","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"},{"name":"Medical Imaging, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruxandra L","family":"Pinto","sequence":"additional","affiliation":[{"name":"Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada"},{"name":"Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoine P","family":"Pronovost","sequence":"additional","affiliation":[{"name":"Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada"},{"name":"Critical Care Medicine, Unity Health Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mypinder","family":"Sekhon","sequence":"additional","affiliation":[{"name":"Critical Care, The University of British Columbia - Vancouver Campus, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunjay V","family":"Sharma","sequence":"additional","affiliation":[{"name":"Surgery, McMaster University, Hamilton, Ontario, Canada"},{"name":"Neurosurgery, Hamilton Health Sciences, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Sinclair","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, Ottawa Hospital, Ottawa, Ontario, Canada"},{"name":"Division of Neurosurgery, University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eve","family":"Tsai","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of Ottawa, Ottawa, Ontario, Canada"},{"name":"Neurosurgery, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5675-8791","authenticated-orcid":false,"given":"Alexis F","family":"Turgeon","sequence":"additional","affiliation":[{"name":"Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Centre Hospitalier Universitaire de Qu\u00e9bec-Universit\u00e9 Laval, Qu\u00e9bec City, Quebec, Canada"},{"name":"Anesthesia and Critical Care Medicine, Universit\u00e9 Laval Facult\u00e9 de M\u00e9decine, Qu\u00e9bec City, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhijit","family":"Warade","sequence":"additional","affiliation":[{"name":"Department of Surgery, P D Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7101-3958","authenticated-orcid":false,"given":"Damon C","family":"Scales","sequence":"additional","affiliation":[{"name":"Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada"},{"name":"Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,12,25]]},"reference":[{"key":"2026010703483103000_15.12.e114158.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(12)70262-4"},{"key":"2026010703483103000_15.12.e114158.2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(18)30415-0"},{"key":"2026010703483103000_15.12.e114158.3","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1097\/TA.0000000000000733","article-title":"Recent trends in hospitalization and in-hospital mortality associated with traumatic brain injury in Canada: A nationwide, population-based study","volume":"79","author":"Fu","year":"2015","journal-title":"J Trauma Acute Care Surg"},{"key":"2026010703483103000_15.12.e114158.4","doi-asserted-by":"crossref","unstructured":"Angriman F , Angeloni NA , Tanenbaum B , et al . Clinical characteristics and outcomes of critically ill adult patients admitted with traumatic brain injury: a cohort study. Can J Anaesth 2025. doi:10.1007\/s12630-025-03057-4","DOI":"10.1007\/s12630-025-03057-4"},{"key":"2026010703483103000_15.12.e114158.5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199412153312401"},{"key":"2026010703483103000_15.12.e114158.6","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31817fdf1c"},{"key":"2026010703483103000_15.12.e114158.7","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000137138.40116.6c"},{"key":"2026010703483103000_15.12.e114158.8","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.amjsurg.2006.12.004","article-title":"Incidence of venous thromboembolism in patients with traumatic brain injury","volume":"193","author":"Denson","year":"2007","journal-title":"Am J Surg"},{"key":"2026010703483103000_15.12.e114158.9","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.clineuro.2018.09.032","article-title":"Anticoagulant prophylaxis against venous thromboembolism following severe traumatic brain injury: A prospective observational study and systematic review of the literature","volume":"175","author":"Hachem","year":"2018","journal-title":"Clin Neurol Neurosurg"},{"key":"2026010703483103000_15.12.e114158.10","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2011.2122"},{"key":"2026010703483103000_15.12.e114158.11","first-page":"886","article-title":"Pharmacologic thromboprophylaxis is a risk factor for hemorrhage progression in a subset of patients with traumatic brain injury","volume":"68","author":"Levy","year":"2010","journal-title":"J Trauma"},{"key":"2026010703483103000_15.12.e114158.12","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2007.0385"},{"key":"2026010703483103000_15.12.e114158.13","doi-asserted-by":"crossref","DOI":"10.1001\/jamasurg.2021.5794","article-title":"Association of Venous Thromboembolism Prophylaxis After Neurosurgical Intervention for Traumatic Brain Injury With Thromboembolic Complications, Repeated Neurosurgery, and Mortality","volume":"157","author":"Byrne","year":"2022","journal-title":"JAMA Surg"},{"key":"2026010703483103000_15.12.e114158.14","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0000000000001432"},{"key":"2026010703483103000_15.12.e114158.15","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-015-0221-y"},{"key":"2026010703483103000_15.12.e114158.16","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1014475"},{"key":"2026010703483103000_15.12.e114158.17","unstructured":"Inc PC . Product monograph, fragmin. Dalteparin Sodium Injection; 2018. Available: https:\/\/www.pfizer.ca\/en\/our-products\/fragmin-dalteparin-sodium-injection"},{"key":"2026010703483103000_15.12.e114158.18","doi-asserted-by":"crossref","DOI":"10.1186\/cc8980","article-title":"Prophylactic anticoagulation to prevent venous thromboembolism in traumatic intracranial hemorrhage: a decision analysis","volume":"14","author":"Scales","year":"2010","journal-title":"Crit Care"},{"key":"2026010703483103000_15.12.e114158.19","doi-asserted-by":"crossref","DOI":"10.1136\/tsaco-2024-001691","article-title":"Venous thromboembolism prophylaxis in adults with acute traumatic brain injury: a systematic review","volume":"10","author":"Forte","year":"2025","journal-title":"Trauma Surg Acute Care Open"},{"key":"2026010703483103000_15.12.e114158.20","doi-asserted-by":"crossref","first-page":"110936","DOI":"10.1016\/j.jocn.2024.110936","article-title":"A systematic review and meta-analysis on the impact of early vs. delayed pharmacological thromboprophylaxis in patients with traumatic brain injury","volume":"132","author":"Shuja","year":"2025","journal-title":"J Clin Neurosci"},{"key":"2026010703483103000_15.12.e114158.21","doi-asserted-by":"publisher","DOI":"10.3310\/hta19880"},{"key":"2026010703483103000_15.12.e114158.22","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.168.16.1805"},{"key":"2026010703483103000_15.12.e114158.23","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0198285","article-title":"Low-molecular-weight heparin venous thromboprophylaxis in critically ill patients with renal dysfunction: A subgroup analysis of the PROTECT trial","volume":"13","author":"Pai","year":"2018","journal-title":"PLoS One"},{"key":"2026010703483103000_15.12.e114158.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2009.03.010"},{"key":"2026010703483103000_15.12.e114158.25","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.44.4.285"},{"key":"2026010703483103000_15.12.e114158.26","doi-asserted-by":"publisher","DOI":"10.4081\/monaldi.2012.121"},{"key":"2026010703483103000_15.12.e114158.27","doi-asserted-by":"publisher","DOI":"10.1016\/S2589-7500(20)30085-6"},{"key":"2026010703483103000_15.12.e114158.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"2026010703483103000_15.12.e114158.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-114158","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T11:52:21Z","timestamp":1767786741000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-114158"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":29,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,25]]},"published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1136\/bmjopen-2025-114158"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-114158","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]}}}