Management of severe traumatic brain injury in regions with limited resources

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 consensus-based documents focused on capacity building for sTBI care as a means of addressing this substantial burden of disease.

Automated summary

Severe traumatic brain injury (sTBI) is a critical health issue in regions with limited resources, with road traffic injuries (RTIs) and violence being the principal mechanisms. Challenges in care include lack of pre-hospital care, overloaded emergency services, insufficient trained personnel, and deficiencies in surgical and intensive care. Collaborations between high-income countries (HICs) and low- and middle-income countries (LMICs) have focused on capacity building for sTBI care to address the high burden of disease in RLRs.