Management of severe traumatic brain injury in regions with limited resources

Abstract

Importance: Severe traumatic brain injury (sTBI) is a critical health problem in regions of limited resources (RLRs). Younger populations are among the most impacted. The objective of this review is to analyze recent consensus-based algorithms, protocols and guidelines proposed for the care of patients with TBI in RLRs. Observations: The principal mechanisms for sTBI in RLRs are road traffic injuries (RTIs) and violence. Limitations of care include suboptimal or non-existent pre-hospital care, overburdened emergency services, lack of trained human resources, and surgical and intensive care. Low-cost neuromonitoring systems are currently in testing, and formal neurotrauma registries are forming to evaluate both long-term outcomes and best practices at every level of care from hospital transport to the emergency department (ED), to the operating room and intensive care unit (ICU). Conclusions and Relevance:The burden of sTBI is highest in RLRs. As working-age adults are the predominantly affected age-group, an increase in disability-adjusted life years (DALYs) generates a loss of economic growth in regions where economic growth is needed most. Four multi-institutional collaborations between high-income countries (HICs) and LMICs have developed evidence and consensusbased documents focused on capacity building for sTBI care as a means of addressing this substantial burden of disease.

Early management of isolated severe traumatic brain injury patients in a hospital without neurosurgical capabilities: a consensus and clinical recommendations of the World Society of Emergency Surgery (WSES)

“…Precisely, we refer to patients admitted to an urban spoke hospital without neurosurgical capabilities in a high-income country with the availability of an intensive care unit (ICU), operating room (OR) and computed tomography (CT) scan. In the case of severe TBI with extra-cranial lesions or admitted to hospitals with limited resources, readers can refer to several published articles/guidelines for initial management [10][11][12][13][14].…”

Managing Severe Traumatic Brain Injury Across Resource Settings: Latin American Perspectives

“…Concurrently, in the LABIC survey mentioned above, only 14.6% of responders indicated that they monitored brain oxygenation; half of them used jugular bulb oxygen saturation, and only 2% among all responders used invasive brain tissue oxygenation monitoring [ 20 ]. Along these lines, the interesting question raised is, if possible, how one can mitigate the various SBI mechanisms via less invasive and less resource-demanding approaches [ 25 ].…”

How to manage traumatic brain injury without invasive monitoring?

“…A recent review summarizes the evidence for severe TBI management in LMICs [73 ▪▪ ]. CREVICE protocol, based on an expert consensus approach, includes three levels of interventions and recommendations for monitoring, general measures, goals for cerebral perfusion and oxygenation treatment and for escalation or tapering therapies [32 ▪▪ ].…”