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Updated: Oct 21, 2025
A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
Published on: March 26, 2019
Management of severe traumatic brain injury in regions with limited resources
Andres M Rubiano1,2, Dylan P Griswold3,4, Manuel Jibaja5
1Professor of Neurosciences and Neurosurgery, Universidad El Bosque - Bogota, Colombia/Medical and Research Director, Meditech Foundation, Cali, Colombia.
Insights
Severe traumatic brain injury (sTBI) disproportionately affects younger populations in resource-limited regions (RLRs). This review analyzes recent guidelines to improve TBI care and reduce the significant burden of disease in these areas.
Area of Science:
- Neurotrauma
- Global Health
- Public Health Policy
Background:
- Severe traumatic brain injury (sTBI) presents a critical health challenge, particularly impacting younger demographics in regions of limited resources (RLRs).
- Road traffic injuries (RTIs) and violence are primary causes of sTBI in RLRs, exacerbated by inadequate pre-hospital care, strained emergency services, and limited human resources.
- The economic impact of sTBI, measured in disability-adjusted life years (DALYs), is substantial in RLRs, hindering economic growth.
Purpose of the Study:
- To review and analyze current consensus-based algorithms, protocols, and guidelines for managing traumatic brain injury (TBI) patients in RLRs.
- To identify strategies for capacity building in neurotrauma care within RLRs.
- To address the significant burden of sTBI in resource-limited settings.
Main Methods:
- Systematic review of recent consensus-based algorithms, protocols, and guidelines for TBI care in RLRs.
- Analysis of multi-institutional collaborations between high-income countries (HICs) and low- and middle-income countries (LMICs).
- Evaluation of emerging low-cost neuromonitoring systems and the development of neurotrauma registries.
Main Results:
- Four collaborative initiatives have produced evidence-based documents focused on enhancing sTBI care capacity in RLRs.
- Ongoing development of low-cost neuromonitoring technologies and formal neurotrauma registries to track outcomes and best practices.
- Identification of key challenges including suboptimal pre-hospital care and resource limitations in emergency, surgical, and intensive care.
Conclusions:
- Addressing the high burden of sTBI in RLRs is crucial for economic development and public health.
- International collaborations are vital for developing and implementing effective TBI care strategies in resource-limited settings.
- Continued research and implementation of standardized protocols, alongside technological advancements, are essential for improving patient outcomes in RLRs.
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.
