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Murine Model of Controlled Cortical Impact for the Induction of Traumatic Brain Injury
Published on: August 16, 2019
Survey of resources available to implement severe pediatric traumatic brain injury management guidelines in low and
Gavin Wooldridge1, Andreas Hansmann2, Omer Aziz3
1Queen Elizabeth Central Hospital, Blantyre, Malawi. gfwooldridge@gmail.com.
Insights
Hospitals in low-middle income countries face resource limitations in implementing severe pediatric traumatic brain injury (TBI) guidelines, particularly for intracranial pressure and cerebral perfusion pathways. International guidelines tailored for these regions may improve patient outcomes.
Area of Science:
- Global Health
- Pediatric Neurology
- Trauma Surgery
Background:
- Traumatic brain injury (TBI) presents a significant global health challenge, with a high incidence and mortality rate in low- and middle-income countries (LMICs).
- While guideline implementation has improved TBI outcomes in high-income countries, their applicability in resource-limited settings remains uncertain.
- Severe pediatric TBI management requires specialized resources and adherence to specific pre-hospital and in-hospital guidelines.
Purpose of the Study:
- To assess the resource availability in LMICs for implementing pre-hospital and severe pediatric TBI management guidelines.
- To identify specific guideline components that pose challenges in resource-constrained healthcare environments.
- To inform the development of contextually appropriate TBI management strategies for LMICs.
Main Methods:
- An anonymous online survey was distributed to healthcare professionals managing severe pediatric TBI in LMICs.
- The survey included 38 questions assessing patient care practices and perceived resource availability for guideline implementation.
- International and national pediatric, intensive care, and neurological societies facilitated survey distribution across 68 countries.
Main Results:
- Of 247 surveyed hospitals, 50% had resources to implement most pre-hospital TBI pediatric guidelines and baseline care recommendations.
- However, significant resource gaps were identified for first-tier therapies, with only 21.5% of hospitals having sufficient resources for intracranial pressure (ICP) management pathways.
- Similarly, only 38.5% of hospitals could implement cerebral perfusion pressure (CPP) management pathways, indicating challenges in advanced TBI care.
Conclusions:
- Implementing advanced pediatric TBI management guidelines, particularly those for ICP and CPP, is resource-intensive and not widely feasible in LMICs.
- The findings highlight a critical need for internationally developed guidelines tailored to the resource limitations of LMICs.
- Context-specific recommendations are essential to improve TBI patient care and outcomes in these vulnerable populations.
Purpose:
Traumatic brain injury (TBI) is a leading cause of death and disability worldwide, with a disproportionately high burden in low-middle income countries. Guideline implementation has been associated with mortality reduction in high-income countries (HIC), but it is not known if hospitals in low and middle-income countries possess the resources to implement the pre-hospital TBI guidelines and the guidelines for the management of severe pediatric traumatic brain injury.
Method:
An anonymous online survey was undertaken by a range of health care professionals currently managing children with severe TBI in low to middle-income countries. A variety of international and national pediatric, intensive care, and neurological societies assisted in the survey distribution. Thirty-eight questions were included to evaluate patient care and the provider's perceptions of their resources available to implement the pre-hospital specific TBI and current pediatric severe TBI guidelines.
Results:
Two hundred and forty-seven hospitals were represented from 68 countries. Fifty percent of LMIC hospitals that responded had the resources to implement 13 of 15 guidelines for the pediatric component of pre-hospital management for TBI and all baseline care recommendations. First tier therapies including the intracranial pressure (ICP) and cerebral perfusion pathways (CPP), however, demonstrated low capacity for uptake with 21.5% and 38.5% of surveyed hospitals possessing sufficient resources to follow the recommended pathways.
Conclusion:
Pediatric TBI ICP/CPP management guidelines require numerous resources not widely sourced in LMIC. The creation of international guidelines that outline recommendations of care for LMIC may benefit patient care and outcomes in these settings.
