Can Neurocritical Care Guidelines Developed in High-Income Countries be Relevant to Low- and Middle-Income Countries?

Area of Science:

• Neuroscience
• Global Health
• Medical Guidelines

Background:

• Guideline-concordant care for brain injury can improve patient outcomes.
• Guidelines from high-income countries (HICs) may not suit low- and middle-income countries (LMICs) due to resource limitations.
• LMICs often lack resources for developing their own guidelines.

Purpose of the Study:

• To explore strategies for developing neurocritical care guidelines that address the specific needs and resource constraints of LMICs.
• To enhance the global impact of professional societies by incorporating LMIC concerns into guideline development.
• To propose methods for framing research questions and recommendations relevant to diverse healthcare settings.

Main Methods:

• Inclusion of LMIC experts in guideline panels.
• Framing Population, Intervention, Comparison, and Outcome (PICO) questions relevant to LMIC settings.
• Utilizing cost-effectiveness evaluation methods and considering local resource availability.

Main Results:

• A significant challenge is the scarcity of high-quality evidence in LMICs, leading to weaker recommendations.
• Guidelines must balance potentially beneficial but expensive interventions with local affordability and resource availability.
• LMIC-focused guidelines can improve prognostication, counseling, and goal-of-care discussions, potentially preventing catastrophic out-of-pocket expenses.

Conclusions:

• Guidelines tailored to LMIC-specific concerns are feasible and can significantly improve the care of critically ill neurological patients worldwide.
• Framing PICO questions around available local alternatives, rather than solely focusing on expensive HIC-standard interventions, is a practical approach.
• Such guidelines can lead to more equitable and effective neurocritical care, even in resource-limited environments.